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Aspirin may not be enough for everyone

New research suggests that some cardiac patients may be resistant to the protective effects of this common approach to secondary prevention of cardiovascular disease.

By Victoria Stagg Elliott, amednews staff. April 22/29, 2002.

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Aspirin has long been a part of treatment for people at high risk of heart attack and stroke. It's cheap and easy to get. It is also credited with reducing cardiovascular events by 25%.

For some patients, though, it may not do all it's supposed to, according to a study published on the Circulation Web site March 25.

The study by scientists in Canada and Australia looked at several hundred people who took part in the Heart Outcomes Prevention Evaluation Study, an international large-scale trial known for demonstrating the benefits of ACE inhibitors.

Researchers studied thromboxane levels in people who experienced a heart attack or stroke during the trial and compared them to those who did not. They found that levels of the substance, which is usually blocked by aspirin, were significantly higher in those who experienced adverse outcomes, and theorize that aspirin therapy may have failed them.

"We now know for the first time that the concept of 'aspirin resistance' is a real one," said Dr. John Eikelboom, an Australian-trained physician and a consultant hematologist at the University of Western Australia in Perth. "Our results suggest that some patients may need more protection than aspirin alone can offer," added Dr. Eikelboom, the paper's lead author.

Reasons for the phenomenon are a matter of speculation, although most believe genetics plays a significant role.

"I can't imagine that there is an overwhelming environmental factor that would be the primary determinant, although certainly there could be some -- dietary, whatever -- that could play into this," said Jeffrey Borer, MD, professor of cardiovascular medicine at Weill Medical College of Cornell University in New York City. [...]