Research by DoM's Dr. Kevin Bainey informs the new Canadian Guidelines on antiplatelet drugs to treat and avoid heart attack, stroke or heart failure
30 October 2023
By Gillian Rutherford, Folio
Should you be taking daily Aspirin to prevent a first heart attack or stroke? New Canadian guidelines released over the weekend suggest it’s not for everyone.
“Historically, the answer was yes, but now routine use for primary prevention is not recommended,” says lead author Kevin Bainey, associate professor of medicine in the University of Alberta’s Faculty of Medicine & Dentistry, interventional cardiologist at the Mazankowski Alberta Heart Institute and researcher with the Canadian VIGOUR Centre.
“The evidence shows the bleeding risk balances the benefits in those who have never had a heart attack,” he says. “However, if you have had a heart attack it is very clear it makes sense to take antiplatelet agents, including Aspirin.”
The new guidelines cover whether and when Canadian patients should take Aspirin and other antiplatelet therapies for the primary or secondary prevention of atherosclerotic cardiovascular disease. Antiplatelet medications prevent the formation of blood clots. Also known as ischemic heart disease or coronary artery disease, the buildup of plaque in the heart’s arteries can lead to heart attack, stroke or death. It’s the second leading cause of death in Canada, according to Health Canada.
Conventional wisdom since the 1980s suggested taking low-dose Aspirin daily was a harmless way for people over 50 to prevent heart attack, but more recent research has revealed daily Aspirin used routinely increases the risk of major bleeding, negating the benefits.
Talk to your doctor
Daily Aspirin could be used for people with high risk factors for heart attack — a family history of premature coronary artery disease, diabetes, high cholesterol, high blood pressure and smoking, Bainey notes.
“A 10 per cent risk reduction is reported consistently in the academic literature,” he says, “but we also need to recognize that bleeding can be harmful.”
The key is to talk to your doctor to decide what’s best for you. The guidelines include a new decision aid tool to guide those conversations based on evidence.
“We really focus on individual patients and determining their cardiovascular risk, their risk of bleeding, and then tailoring antiplatelet therapy to maximize the outcomes for those patients,” says Bainey. “So it’s really taking it to a different level; we’re the first in the world to endorse a shared decision-making model between the doctor and the patient for using Aspirin as primary prevention.”
Bainey had this very conversation with his own father, who has not had a heart attack but has diabetes, high cholesterol, high blood pressure and a low risk of bleeding. His dad is now taking antiplatelet therapy to address those risk factors.