U of M to expand low-dose aspirin campaign as stroke, heart attack prevention

An apple a day may keep the doctor away, but a low-dose aspirin a day could keep thousands of Minnesotans out of the emergency room by helping to prevent a first heart attack or stroke.

That's the message of a five-year statewide campaign that will be launched this spring by the University of Minnesota, together with Target stores and primary care providers, that aims to reach people who would benefit from aspirin and can withstand its potential adverse effects.

Organizers hope to demonstrate that an over-the-counter medicine that costs just 2 to 3 cents a day can prevent many cataclysmic cardiovascular events, saving lives and millions of dollars in health care costs. The National Institutes of Health is backing a study of the campaign with a $3.6 million grant, and the organizers hope to raise up to $7 million more.

The program targets men age 45 to 79 and women age 55 to 79 who are deemed to be at moderate to high risk of heart attack or stroke. Risk factors include advancing age, family history of heart attack or stroke, smoking, diabetes, high blood pressure and high cholesterol.

After a trial version of the study in Bemidji, the U reported last May that the proportion of the targeted population taking low-dose aspirin rose to 54 percent from 36 percent in just four months — an effect that lasted the full 16 months of the study.

The results shocked researchers, who had predicted a just 5 percent increase, said Dr. Alan T. Hirsch, a U cardiologist leading the studies.

If that pattern can be achieved statewide, as many as 7,000 first heart attacks and strokes a year could be prevented over the next five years, Hirsch said.

"We didn't say, 'Go buy aspirin.' We said, 'Figure out if you're the right person — the right heart risk and the lowest bleeding risk. Have guidance, and then commit.' "

Hirsch predicted that whatever the study's outcome, it will spark controversy.

The Journal of the American College of Cardiology published a paper recently saying that more than 1 in 10 people on a national cardiovascular disease registry who regularly took low-dose aspirin should not be doing so.

The risks of internal bleeding associated with aspirin use outweigh any potential benefit for patients without cardiovascular disease who are at a low risk of developing it within a decade. Aspirin use is considered appropriate only in patients with 10-year disease risk of at least 6 percent, according to the guidelines on primary prevention of cardiovascular disease.

"The key part is appropriate use," said John Finnegan Jr., a professor and dean of the U's school of public health. He said the project will include a mass media campaign urging people to talk with their health care providers to see whether aspirin is appropriate for them.

Finnegan said surrounding states would be used as a control group to gauge the effects of the campaign.

Target Corp. said in a prepared statement that it will cooperate in the study by posting signs in 27 Minnesota stores encouraging patrons to talk to their providers about whether low-dose aspirin is appropriate for them. The company declined to make anyone available to discuss the project.

Dr. Russell Luepker, an epidemiologist with the U's School of Public Health who is working on the study, said he believes it will save several thousand lives over the next five years.

Luepker participated in the first large randomized trial of aspirin as a preventive therapy for cardiovascular disease. Although he got the placebo, the results of that study convinced him that the blood thinning effects of aspirin could prevent platelets from clotting, and he now takes low-dose aspirin himself.

Most people can tolerate aspirin without adverse effects, Luepker said.

"All of us are at risk for heart attacks but it seems like in our area, our stroke rate is a little higher," said Dr. George Morris, CentraCare's medical director. "So we're hoping that in the long term this will help us minimize both."

CentraCare tapped its electronic medical records to identify about 1,600 patients who might have a net benefit by adding a daily aspirin to their regimen, Morris said. When they showed up at the clinic, the system prompted their providers to talk with them about the potential benefits and risks of taking aspirin.

"We had about 1,500 patients that weren't previously taking aspirin that now are," Morris said. The remainder, he said, made reasoned decisions for not taking it.

Morris himself is a believer.

"I'm in the 45 to 50 age group and I've been taking it for a few years," Morris said.