Doctors have found a drug that is better than aspirin at preventing heart attacks and strokes, in a discovery that could transform health guidelines worldwide.
For decades, millions of people have been advised to take aspirin to reduce their risk of experiencing a serious cardiovascular event. A daily low-dose aspirin makes blood less sticky and helps prevent heart attacks and strokes.
But now a new study, presented at the world’s largest heart conference, has found that clopidogrel, a commonly prescribed blood thinner, is more effective – and with no extra risk.
The discovery was revealed at the European Society of Cardiology congress in Madrid, with the data behind the findings simultaneously published in the Lancet medical journal.
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The international team of medics behind the study, from countries including the US, UK, Australia, Switzerland and Japan, said the results showed that clopidogrel was “superior” to aspirin and should lead to “extensive adoption” of the drug in clinical practice worldwide.
Their comprehensive analysis of nearly 29,000 patients with coronary artery disease (CAD) found that clopidogrel was better than aspirin in preventing serious heart and stroke events, without increasing the risk of major bleeding.
CAD is the most common form of heart disease and a leading cause of death and disability globally. More than 300 million people live with CAD.
It occurs when arteries in the heart become narrowed by a buildup of atheroma, a fatty material within their walls. The pain or discomfort felt from such narrowing is called angina and if a blockage occurs, it can cause a heart attack.
The findings challenge the longstanding recommendation of aspirin as the default treatment for preventing serious cardiovascular events in hundreds of millions of CAD patients.
CAD often requires lifelong treatment to prevent heart attacks, strokes and cardiovascular death. Aspirin has traditionally been prescribed indefinitely for patients with the condition.
However, the evidence supporting aspirin’s long-term benefits and safety has been limited. The new analysis of seven clinical trials found that patients taking clopidogrel had a 14 per cent lower risk of major adverse cardiovascular or cerebrovascular events – including heart attack, stroke or cardiovascular death – compared with those taking aspirin.
Importantly, the rates of major bleeding issues in patients were similar between the two drugs, dispelling concerns that clopidogrel might lead to more bleeding complications.
Writing in the Lancet, the study team said: “This comprehensive synthesis of available evidence indicates that, in patients with CAD, long-term clopidogrel monotherapy offers superior protection against major cardiovascular and cerebrovascular events compared with aspirin, without an excess risk of bleeding.
“The superior efficacy of clopidogrel v aspirin was consistent across multiple key subgroups, including individuals with clinical features predictive of poor clopidogrel responsiveness, supporting the generalisability of these findings to the broad spectrum of patients with CAD.
“These results support a preference for clopidogrel over aspirin for chronic antiplatelet monotherapy for patients with stable CAD. The widespread availability, generic formulation and affordability of clopidogrel further supports its potential for extensive adoption in clinical practice.”
The analysis drew from diverse patient groups, including those who had undergone procedures such as stent placement or had experienced acute coronary syndrome, and examined various subgroups to ensure the findings applied broadly.
Notably, even patients who might respond less well to clopidogrel as a result of genetic or clinical factors still benefited from its use over aspirin. The results suggest that clopidogrel should be considered the preferred long-term anti-platelet medication for patients with CAD.
Because both medications are widely available, the findings have the potential to influence clinical guidelines worldwide and improve patient outcomes. Further research on the cost-effectiveness of clopidogrel, as well as broader population studies, will be needed to support changes in treatment standards.
Prof Bryan Williams, the chief scientific and medical officer at the British Heart Foundation, said: “Aspirin is a commonly prescribed drug to help prevent repeat heart attacks and strokes. This research suggests that clopidogrel, an alternative to aspirin, might be more effective at preventing recurrent heart attack or stroke.
“Importantly, these benefits come without a greater risk of major bleeding. These findings are likely to impact the medications doctors prescribe to their patients to reduce their risk of future heart problems.” - Guardian
