Aspirin could help save a further 3,000 lives in Britain each year - 40,000 worldwide - if it was more widely used to combat disease in patients at higher risk of heart attacks and strokes, researchers said last night.
The drug's anti-clotting properties were already responsible for preventing thousands of premature deaths and reducing the risk of non-fatal attacks but could still achieve greater success in patients with conditions such as diabetes and peripheral arterial disease, where fatty deposits built up in the leg's arteries and could lead to heart attacks and strokes.
A review of results from 287 drug trials involving more than 200,000 patients concluded that the inexpensive aspirin was still under-used, partly because of lack of clear medical advice on its benefits for people who were at extra risk of serious vascular disease, but who had not yet suffered a heart attack or stroke.
But not all heart specialists are convinced. One said the results were inconclusive and that use of aspirin might simply lead to a "cosmetic" reduction in non-fatal attacks and change the way conditions presented themselves rather than prevent them.
Aspirin is routinely used for patients who have suffered a heart attack or stroke. Many people over 50 take it regularly without doctors' advice because of its reputation in combating heart disease, a habit doctors say should be discouraged because the risks of ulcers and internal bleeding might outweigh potential benefits in staving off heart disease.
The new study of aspirin's efficacy by the antithrombotic triallists' collaboration, at the Radcliffe infirmary, Oxford, was published in the British Medical Journal. It was funded by the Medical Research Council and the British Heart Foundation and suggested that aspirin and other anti-coagulants led to reductions of about a quarter in heart attacks, strokes and death from a range of causes.
Colin Baigent, who led the research, said: "What we need is to ensure that aspirin, or some other platelet drug, is routinely considered for patients who might need it."
Surveys had suggested that less than a quarter of patients suffering from conditions such as peripheral arterial disease were being prescribed aspirin. "We believe that aspirin may well have helped to protect these high risk patients but sadly many will die from their very first heart attack, by which time aspirin is too late."
Charles George, medical director of the heart foundation, said: "Aspirin is not an appropriate treatment for everyone but it is important that all those who benefit are offered it."
But John Cleland, of Hull University, suggested there was no evidence aspirin saved lives after heart attacks. Writing in the same journal, he questioned whether aspirin was safe or cheap. Trials excluded patients at risk while even low dose aspirin already used to guard against heart disease might account for nearly a third of cases of gastro-intestinal bleeding in patients.
