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    "Super Aspirin" Reduces Heart Attacks in People With High Cholesterol

    Taking a new "super aspirin" drug called clopidogrel (Plavix) can reduce the chances of having a heart attack for people with high cholesterol.

    This is the finding of researchers at The Cleveland Clinic Foundation, who examined the medical records of more than 3,700 patients involved in the Clopidogrel vs. Aspirin in Patients at Risk of Ischemic Events (CAPRIE) trial. The results were presented at the 49th annual meeting of the American College of Cardiology in Anaheim, Calif.

    Clopidogrel is called a super aspirin because, like aspirin, it helps prevent blood from clotting, but does it more effectively.

    "Patients with established atherosclerosis (fatty buildup in the arteries) suffer with repeated heart attacks and stroke," said Deepak Bhatt, M.D., lead investigator. "Aspirin may not be as effective as clopidogrel in preventing these events in people with high cholesterol."

    All of the patients in the randomized, double-blind study had high cholesterol and had experienced a stroke, heart attack or vascular problem such as amputation. They all were taking a statin - a drug that lowers cholesterol. In addition, they took either 325 milligrams (5 grains or one adult tablet) of aspirin once a day, or 75 milligrams of clopidogrel once a day.

    Those who took clopidogrel had a nearly 19 percent decrease overall of events like stroke, mini-stroke, heart attack or re-hospitalization for related problems. Most notable was the nearly 57 percent reduction of heart attacks, and the 34 percent reduction of strokes.

    "Based on current evidence, I would give clopidogrel to patients who are taking statins," Bhatt said. "Even when patients are being treated with medication to lower their cholesterol, clopidogrel offers further protection against heart attack and stroke."

    The patients in this study took either the aspirin or clopidogrel for a mean duration of 1.6 years, "but presumably this is a life-long regime," Bhatt added.

    Clopidogrel has two advantages over other super aspirins: It can be taken orally instead of intravenously, which means it can be taken at home; and clopidogrel does not require continuing blood tests to monitor blood clotting times. Both of these factors should increase patient compliance, Bhatt said.

    "We also suggest that the use of cholesterol-lowering therapy after myocardial infarction (heart attack) may become the standard of care," he added.

    Although some physicians are prescribing both aspirin and clopidogrel for patients with cardiovascular disease and high cholesterol, "it is too early at this point to say whether this is better than using clopidogrel alone," Bhatt said. "There are, however, studies going on right now looking at giving both aspirin and clopidogrel for a year to patients with acute coronary syndrome."


    Editorial Comment: Aspirin is one of the most effective drugs we have to prevent heart attacks. It is, however, a relatively non-specific drug. As we better understand the precise mechanism of how aspirin works and how blood clots form, we are able to devise newer, more specific drugs that can block thromboxane production, while continuing to produce protective molecules, thereby limiting side effects.

    Clopidogrel is a member of a class of drugs called thromboxane synthase inhibitors. Aspirin drugs inhibit the production of molecules called prostaglandins, including thromboxane. In turn, thromboxane causes platelets to clump together. Clopidogrel is called a "super aspirin" because it has an additive beneficial action: it not only blocks the production of thromboxane, which normally promotes platelet aggregation, but also preserves the positive effects of prostacyclin. This is a very active field of drug development, not only for heart disease but for all inflammatory conditions. Aspirin is likely to be replaced very soon by these new drugs. But we must make sure in randomized trials that there are no unexpected surprises with these drugs.



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