The conclusions in the Sheffield review published today in Heart on the risks and benefits of aspirin treatment in coronary heart disease err on the conservative side, as admitted by the authors.

It reports on the successful use of aspirin to prevent death or other event in people at high risk of heart disease. It warns however about the unnecessary use of daily aspirin in people with a relatively low risk.

The Aspirin Foundation believes that patients with any risk of heart disease should always consult a doctor before embarking upon a course of aspirin or any other medication.

A paper, not included in their survey, was published recently in The Lancet (Jan 2001.357.89-95) reporting a major trial in Italy of 4,500 patients including 2,500 females. Significant benefits were recorded. Reporting on this work, Professor de Gaetano said that there was a slight increase in non fatal bleeding episodes. In five fatal cases of bleeding, four of the patients were not in the aspirin group. There were a few haemorrhagic strokes, three in the non aspirin group and two in the aspirin group.

Identification of patients at risk included those over 65 years of age with hypertension and high blood cholesterol. Diabetes and obesity were also risk factors as was a family history of early heart disease.

In an ongoing trial in Scotland entitled aspirin Asymptomatic Atherosclerosis Trial (AAA) peripheral vascular disease which may be asymptomatic is used as an entry criterion. The research team measure ankle and arm blood pressure as a measure of risk of heart attack or stroke, regardless of smoking, high blood pressure or high blood cholesterol. Patients identified as at risk are divided into those receiving aspirin and those receiving placebo. The estimate is one aspirin taken daily can save the life of one in a hundred people at high risk.

The Sheffield Review simply records a well accepted medical view that indiscriminate use of aspirin by people at low risk of heart disease is not recommended. In all cases the Aspirin Foundation believes that medical opinion should be sought before any medication is used.