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For decades, a daily dose of aspirin has been widely regarded as a way to protect healthy people from cardiovascular disease and even cancer. But a large international study reveals that even at low doses, long-term use of aspirin can be harmful – without any benefit – for older people who have not had a heart attack or stroke before.
The new research reinforces the results of a study published at the end of August, which revealed that low-dose daily aspirin was too risky to be prescribed to patients with a moderate risk of cardiac disease. In the August study and the new study, the researchers found a significant risk of internal gastric bleeding caused by the drug, which thinned the blood. According to the new report, published Sunday in the New England Journal of Medicine, elderly patients had no benefit to health.
"We knew that there would be an increased risk of bleeding with aspirin because there has always been one," said Dr. Anne Murray, a geriatrician and epidemiologist at the Institute for Research in Medicine. Hennepin Healthcare and the University of Minnesota Minneapolis. has not decreased the risk of disability or death, it has not decreased the risk of heart attack and stroke, and the death rate has increases. "
"For healthy people 70 years and older who have no reason to take aspirin, such as a heart attack or stroke, there was no noticeable benefit."
Current guidelines recommend daily aspirin for adults in their 50s who are at high risk of cardiovascular disease, high blood pressure, high cholesterol, or smoking history. The new study aimed to determine if low-dose aspirin could prolong a healthy and independent life in the elderly who had not shown signs of heart disease.
"For healthy people 70 years of age and older who have no reason to take aspirin, such as a heart attack or stroke, there was no noticeable benefit," Murray said. at NBC News.
The trial followed 19,114 seniors – 2,411 from the United States and 16,703 Australians – for an average of 4.7 years. The minimum age was 70 for Caucasian participants and 65 for African American and Hispanic volunteers, due to their higher risk of dementia and cardiovascular disease.
At the end of the trial, 90.3% of patients treated with aspirin were still alive, compared with 90.5% of those who received placebos. Rates of physical disability and dementia were similar between groups. The rates of coronary heart disease, heart attacks, and stroke were also similar.
The big difference between the groups was the rate of internal bleeding. Hemorrhagic strokes, cerebral hemorrhages, gastrointestinal bleeding and hemorrhage in other sites requiring transfusion or hospitalization occurred in 361, or 3.8% of participants in the aspirin group. and 265, or 2.7%.
Increased cancer risk?
There was also an increase in cancer deaths in the aspirin group, which surprised the researchers. Previous studies have shown that aspirin can protect against certain types of cancer.
"There has been a small increase in the total number of deaths in the aspirin group, with the largest proportion of cancer deaths," Murray said. "It is possible that pre-existing cancers have interacted with aspirin."
In the end, there may be more benefits than risks in some populations, said lead author John McNeil, a professor of epidemiology at the School of Public Health and Preventative Medicine. Monash University in Melbourne.
"But we have not identified remarkably different results," McNeil said in an email. Other research likely to identify groups likely to benefit from regular use of aspirin are ongoing.
Dr. Erin Michos, a cardiologist, described the results as "alarming", saying that aspirin should only be prescribed selectively.
Major changes have taken place in preventive medicine since initial research on aspirin, said Michos in an email. Patients are now receiving statins to lower cholesterol and antihypertensive drugs to lower blood pressure.
"It's time we start phasing out the use of aspirin for prevention purposes in people who have not had a heart attack or stroke," he said. said Michos, director of preventive cardiology at the Center Ciccarone for the prevention of heart. Illness at the Johns Hopkins School of Medicine.
Dr. Ravi Dave says that aspirin can be helpful for a small group of healthy elderly patients, even if they have not already had a heart attack or stroke, such as smokers. But for healthy patients who have not had a heart attack or stroke and are not at high risk, "I would consider removing them," said Dave, director of interventional cardiology at University of California at Los Angeles.
This is a decision that Dr. Mark Huffman plans to take in conversations with his patients.
"Some will say, 'If it's not broken, do not fix it,'" predicted Huffman, associate professor of preventive medicine at the Feinberg School of Medicine at Northwestern University and a cardiologist at Northwestern Medicine. "Others will say," If the data suggests that I have no benefit, I would like to take fewer pills. "
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