Drug costing less than 4p a day lowering heart attack and stroke risks

Millions of Britons who take aspirin to lower their risk of heart attack and stroke could get far greater benefits from an alternative drug that costs less than 4p a day, a study suggests.

Patients diagnosed with coronary artery disease (CAD) are typically advised to take a daily aspirin to thin their blood and cut their odds of suffering a serious cardiac event.

But a major new review found switching to a different thinner named clopidogrel reduces the risk of heart attack, stroke or death by an additional 14 per cent.

The global consortium of researchers, including from Imperial College London, say it offers ‘superior protection’ and there is a strong case for making it the preferred option in clinical practice.

Their findings were simultaneously published in The Lancet medical journal and presented at the European Society of Cardiology congress in Madrid.

Coronary artery disease, also known as coronary heart disease, is the most commonly diagnosed type of heart disease and affects 2.3million people in the UK.

It occurs when arteries in the heart become narrowed by a build-up 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.

 Patients with CAD have traditionally been put on aspirin for the rest of their life but evidence supporting its long term benefits and safety have been limited.

Now researchers have analysed seven previous randomised trials involving 28,982 patients with CAD who had been taking clopidogrel or aspirin, known as antiplatelet medications.

After an average of 5.5 years, those on clopidogrel were 14 per cent less likely to have suffered a heart attack or stroke or to have died from a heart-related condition than those on aspirin.

The analysis drew from diverse patient groups, including those who had undergone procedures like stent placement or had experienced acute coronary syndrome.

It also examined various subgroups to ensure the findings applied broadly.

Notably, even patients who might respond less well to clopidogrel due to genetic or clinical factors still benefited from its use over aspirin.

And there was no statistically significant difference in rates of major bleeding, a known but rare side-effect of taking blood thinners.

Writing in The Lancet, the experts 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 versus 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 review identified 256 deaths or incidents of major bleeding in the clopidogrel group and 279 in the aspirin group, giving rates of 0.71 and 0.77 per 100 patient years, respectively.

However, the difference in these death and bleeding rates was not statistically significant.

The NHS drug tariff indicates a 28 pack of 75mg clopidogrel tablets, which are widely used to prevent blood clots, costs just £1.01 or 3.6p each.

The same size pack of 75mg aspirin tablets cost 69p or 2.5p each.

The authors say that because both medications are widely available, the study’s findings have the potential to influence clinical guidelines worldwide and improve patient outcomes.

 However, further research on the cost-effectiveness of clopidogrel, as well as broader population studies, is needed to support changes in treatment standards, they add.

Professor Bryan Williams, 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.’