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Should healthy seniors start taking aspirin to prevent heart attacks, strokes, dementia and cancer?
No, according to a study of more than 19,000 people, including whites 70 years and older, blacks and Hispanics 65 years and older. They took aspirin at low doses – 100 milligrams – or placebo every day for a median of 4.7 years. Aspirin did not help them – and may have hurt.
Taking it has not reduced their risk of cardiovascular disease, dementia or disability. And this increased the risk of significant bleeding in the digestive tract, brain, or other sites requiring transfusions or admission to the hospital.
The findings were published Sunday in three articles in the New England Journal of Medicine.
A disturbing result puzzled researchers because it had not occurred in previous studies: a slightly higher mortality rate among those taking aspirin, mainly because of cancer mortality. The authors cautioned against the need to further explore this finding before drawing conclusions. Scientists do not know what to do with it, not least because previous studies had suggested that aspirin could reduce the risk of colorectal cancer.
The researchers expected that aspirin would help prevent heart attacks and strokes in the study participants. The results were therefore a surprise – "ugly facts that destroy a beautiful theory", The study leader, Dr. John McNeil, of the Department of Epidemiology and Preventive Medicine at Monash University in Melbourne, Australia, said during a phone interview.
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The news can also be a shock for millions of people who conscientiously swallow their daily pills as a magic potion to ward off all kinds of ills. Although it can be said that aspirin can help people who have already had heart attacks or strokes, or are at high risk, the value of the drug is not very clear to people who are less exposed. , especially the older ones.
The new report is the latest in a recent series of clinical trials to determine who should really take aspirin. A study published in August did not reveal any benefit in low-risk patients. Another found that aspirin could prevent cardiovascular events in people with diabetes, but that the risk of major bleeding outweighed the benefits.
A third study showed that the dose is important and that heavier people might need more aspirin to prevent heart attacks, strokes and cancer.
The most recent discoveries apply only to people like those in the study: in the same age ranges and without a history of dementia, physical disability, heart attack or pain. Stroke; (Blacks and Hispanics have been included in the study at an earlier age than whites because they pose higher risks than whites for dementia and cardiovascular disease.)
The message to the public is that healthy seniors should not start taking aspirin.
"If you do not need it, do not start it," said Dr. McNeil.
But those who already use it regularly should not quit on the basis of these findings, he said, recommending to consult their doctor first.
Dr. McNeil also pointed out that the new findings do not apply to people who have ever had heart attacks or strokes, which usually involve blood clots. These patients need aspirin because it inhibits clotting.
The study, named Aspree, is important because it answers the unanswered question of whether healthy seniors should take aspirin, said Dr. Evan Hadley, director of the geriatrics and gerontology division National Institute of Aging. the research. The National Cancer Institute, Monash University and the Australian Government also paid. Bayer provided aspirin and placebos, but had no other role.
"For healthy seniors, there's always a good reason to talk to their doctors about what these results mean to them individually," said Dr. Hadley. "It's the average for a large group. A doctor can help you understand how this applies individually. It is especially important for people who are already taking aspirin for over 70 years. The study did not include many people who had taken it, and it does not address the issue of prosecution or arrest. "
For people aged 60 to 69 with the same level of risk, the guidelines indicate that the decision to take aspirin should be made individually.
But for people 70 years and older, the guidelines indicate that there is not enough evidence to make recommendations.
Aspree was designed to fill the lack of information for the elderly.
Rather than examining only individual conditions, the study also attempted to assess the effect of aspirin on "disability-free survival," which means it could help seniors prolong their healthy lives. and independent.
"Preventive medicine focuses on the elderly, how to keep them out of nursing homes, alive and well," said Dr. McNeil. "Why does an older person take a medicine if it does not keep them alive and healthy? A lot of previous studies have focused on aspirin and heart disease. But many drugs do good and bad things. Just looking at one does not seem to be enough.
The study included 16,703 people from Australia and 2,411 from the United States as of 2010. They were randomly selected to take low-dose aspirin (100 milligrams daily) or a placebo. That's slightly more than the widely sold dose that most people take, 81 milligrams.
With a median follow-up of 4.7 years, both groups showed no significant difference in their rates of dementia, physical disability or cardiovascular problems.
But those who took aspirin were more likely to have severe bleeding – 3.8% versus 2.7% in the placebo group.
Mortality rates were also different: 5.9% in the aspirin group and 5.2% in the placebo group. Much of the difference was due to a higher rate of cancer deaths.
Dr. McNeil said his team could not explain the apparent increase in cancer deaths. They wondered whether the excessive bleeding may have contributed to the mortality in cancer patients, but they have not been proven. They will continue to follow the participants and study tissue samples from deceased cancer patients.
Although it may seem counterintuitive, he said that the discovery of cancer does not rule out the possibility that aspirin can help prevent colorectal malignancies. The protective effect may not appear until people take aspirin for some time, longer than the average follow-up of the study.
Dr. McNeil, 71, does not take aspirin.
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