Age Thresholds for Routine Aspirin Use Defined

If aspirin is to be used routinely for primary prevention of cardiovascular disease, it should begin at age 48 in men and 57 in women, according to a report in the November issue of Heart. Below these thresholds, the authors conclude, the risks of chemoprophylaxis with aspirin likely outweigh the benefits. Still, they emphasize, these thresholds only apply to individuals without cardiovascular risk factors; when such factors are present, the age thresholds are lower.

The findings are based on a study of 11,232 patients drawn from 304 general practices in England and Wales. Eligibility criteria included age between 30 and 75 years, no prior treatment with lipid-lowering agents, and no history of diabetes or cardiovascular disease.

The focus of the study was the age at which subjects developed an estimated 10-year heart disease risk of 10% or higher, senior author Dr. I. Idris, from Sherwood Forest Hospitals in Sheffield, UK, and colleagues note. For men, that occurred at 47.8 years and for women, at 57.3 years.

In a related editorial, Dr. Peter Elwood, from Cardiff University, UK, and Dr. Gareth Morgan, from Welsh Aspirin Group, Swansea, UK, comment that the idea of basing routine aspirin use on age alone was probably first put forth in 1991. However, they note, this proposal is still hotly debated.

"Before aspirin prophylaxis is widely recommended," they add, "work should be done to identify the safest and best absorbed formulation of the drug, and to examine the effect of taking it with food, or perhaps with milk."

Heart 2008;94:1364-1365,1429-1432.

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FACT:  

Obesity Propensity Starts In Womb?: "The fact fetal rats develop a propensity for obesity while in the womb of their fat mothers has implications for humans.  In addition, the study found metabolic programming occurs in the fetal hypothalamus, the area of the brain responsible for maintaining the body’s energy homeostasis — body weight — throughout life.  Levels of the hormones insulin and leptin also were elevated in fetuses of these obese mother rats — abnormalities that have been correlated with increased appetite and insulin resistance, a prelude to diabetes, as well as obesity and hypertension, the researchers said. "The fact that more than one-third of women of child-bearing age in the United States are expected to be overweight or obese during pregnancy, based on a 2003 study, does not portend well for good health of their offspring." American  Journal of Physiology, Endocrinology and Metabolism, Nov 2007