NUI Galway professor leads debate on aspirin use to prevent heart disease and stroke

Bill McEvoy, an expert in heart disease prevention who last year returned to Ireland to take up the position of Professor of Preventive Cardiology at NUI Galway and Consultant Cardiologist at Galway University Hospitals, has been invited to debate another international expert on the benefits of aspirin in preventing heart disease and stroke.

This debate is important because aspirin is so widely used and because it will also be published in the New England Journal of Medicine, the premier international medical publication, which is widely read by doctors around the world.

In a statement Professor Bill McEvoy, NUI Galway and Galway University Hospitals, said: “As an Irish physician, its great to be invited to lead this international debate among physicians around the world. I’m proud that Galway and Ireland are flying the flag of heart disease and stroke prevention and this article is great exposure for the research we are carrying out at NUI Galway and the National Institute of Preventive Cardiology, also based in Galway.”

Professor McEvoy argues that aspirin continues to have a role in certain patients who are at high risk for heart disease and stroke but who have yet to suffer a clinical manifestation (also known as the ‘primary prevention’ of cardiovascular disease ). On the other hand, Professor Sigrun Halvorsen from the University of Oslo in Norway argues that the use of aspirin in primary prevention of cardiovascular is no longer justifiable. Both agree that aspirin should be continued in those who have already suffered a clinical heart attack or stroke, in order to reduce the chances of a recurrence (termed ‘secondary prevention’ ).

Clinical trials

The motivation for this major debate among physicians is based on three recent 2018 clinical trials that suggested aspirin is less effective in the primary prevention of cardiovascular disease than had been previously thought. Older clinical trials, carried out before the turn of the millennium, had demonstrated that aspirin can prevent heart attacks and strokes among adults who were at sufficiently high risk. However, these trials were done at a time when smoking was more common and the treatment of high blood pressure and high cholesterol was less effective than what is available today.

In the 2018 trials, the benefits of aspirin in preventing heart disease and stroke appeared to have been less pronounced in adults treated to current best practice standards (participants in the 2018 trials had much better control of their blood pressure and cholesterol than did the participants in older trials of aspirin ). This suggests that aspirin may no longer be necessary for primary prevention as long as cardiac risk factors like smoking, high cholesterol, and high blood pressure are well controlled with modern treatments. Because aspirin causes increased bleeding, particularly in the stomach, there have consequently been arguments to now stop using aspirin for the primary prevention of cardiovascular disease altogether.

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