For decades, aspirin has been the go-to medication for people living with coronary artery disease (CAD), a condition in which the heart’s arteries become narrowed and increase the risk of heart attacks and strokes.
But new research published in The Lancet suggests that another blood thinner, clopidogrel, could be a better option for long-term treatment.
Coronary artery disease is one of the leading causes of death worldwide, and patients diagnosed with it often need lifelong therapy to prevent serious cardiovascular events.
Aspirin has been the default prescription for secondary prevention—that is, treatment after a heart problem has already occurred.
While aspirin is inexpensive and widely available, the scientific evidence supporting its long-term use has always had some gaps.
The new study pooled data from seven large clinical trials, covering nearly 29,000 patients with CAD.
The researchers compared outcomes in patients who took aspirin with those who took clopidogrel, another commonly prescribed blood thinner.
The results were clear: patients on clopidogrel had a 14 percent lower risk of major events such as heart attack, stroke, or cardiovascular death compared with those on aspirin.
What makes the findings even more significant is that clopidogrel did not lead to more bleeding complications, a concern that has often limited its use in long-term therapy.
Both aspirin and clopidogrel thin the blood, which reduces clotting but raises the risk of bleeding. In this analysis, the risk of major bleeding was about the same for both drugs, suggesting that clopidogrel offers better protection without added danger.
The researchers examined a wide range of patient groups, including those who had stents placed to open blocked arteries or who had experienced acute coronary syndrome, a severe type of heart attack.
The benefits of clopidogrel held true across these groups, even for patients who might be less responsive to the drug due to genetic or medical factors.
These findings could have a far-reaching impact on clinical guidelines worldwide. If clopidogrel consistently proves to be more effective and just as safe, doctors may begin prescribing it as the first choice for long-term secondary prevention in CAD patients, replacing aspirin as the standard therapy.
However, the researchers note that more studies are needed to fully evaluate the cost-effectiveness of clopidogrel and to confirm the results in broader populations. Both medications are widely available, but aspirin has the advantage of being cheaper and deeply ingrained in medical practice.
Still, this new analysis provides strong evidence that clopidogrel may offer better long-term protection for millions of people living with heart disease.
For patients, the message is clear: if you are taking aspirin for heart disease, it may be worth having a conversation with your doctor about whether clopidogrel could be a safer and more effective option for you.
If you care about heart health, please read studies that vitamin K helps cut heart disease risk by a third, and a year of exercise reversed worrisome heart failure.
For more health information, please see recent studies about supplements that could help prevent heart disease, stroke, and results showing this food ingredient may strongly increase heart disease death risk.
Source: Lancet.
