Healthy seniors should think twice before starting to take aspirin: Study

A daily aspirin may present more risks than benefits if you are over 70, according to a new study published this week in the New England Journal of Medicine. Yet, aspirin, called "miracle drug" against heart disease, is taken regularly by about 50% of adults across the country.

The clinical trial, called ASPREE – Aspirin in reducing events in the elderly – was conducted by researchers from Melbourne's Monash University and studied healthy elderly adults who were taking a low dose of aspirin a day for almost five years. .

That discovered the study?

Aspirin, known to help fight heart disease in people at risk, has not improved life expectancy without dementia and disability in adults over 69 years. The death rate, dementia or the same in people who took aspirin and those who took a placebo tablet.

Aspirin, like any medication, has side effects and can lead to an increased risk of bleeding in the digestive tract and brain. People who took aspirin in this study had a 3.8% risk of bleeding; those who did not take it had a chance to bleed 2.8%.

The most worrying consequence for healthy adults over 69 years of age was an increased risk of death, including deaths from cancer. The risk of death, whatever the cause, was 5.9% in the aspirin group and 5.2% in the placebo group. Cancer was the leading cause of the higher death rate: 3.1% of people taking aspirin died of cancer, compared with only 2.3% of people who took it. not.

What do they mean by "healthy older people"?

ASPREE examined the effects of low-dose daily aspirin in "healthy" elderly people who had no history of heart disease, stroke, dementia, or dementia. other important chronic diseases. All Caucasians were 70 years old or older, and blacks and Latinos were 65 and over.

Most of our current knowledge about the effectiveness of aspirin comes from studies of people with heart problems – a history of heart attacks, strokes or other cardiovascular diseases. In this sicker population, studies are clear: Aspirin helps reduce death rates, prevent heart attacks and strokes, and reduce the risk of colorectal cancer.

An important note: this study does NOT suggest that people should stop taking aspirin if they have a history of heart disease. But the results mean that doctors can rethink the role of aspirin in preventing heart disease.

What is the quality of the new evidence?

In short, the new evidence is quite strong. The ASPREE trial was extensive, involving more than 19,000 people from 34 locations in the United States and 16 locations in Australia. It was a randomized clinical trial (RCT), the most reliable type of research – half of the people involved were randomly assigned to take low-dose aspirin daily and the other half a daily placebo, a pill identical to aspirin. but does not contain the active ingredient. The people participating in the study had no way of knowing whether or not they were taking the active drug, any more than the doctors who gave them the pill. Large RCTs such as this one are widely considered in the scientific community as the most useful for understanding the effects of drugs.

But this study did not tell us much. The authors caution against the fact that the increase in mortality rate in the group taking aspirin was so low that it could have been a coincidence. Aspirin has been widely studied and this negative effect goes against the results of many important previous studies. In addition, 91% of the people participating in the study were Caucasian, so the effects on black and Hispanic people are harder to interpret.

The trial was also relatively short. The researchers followed people for about four and a half years. There is not much time to detect the potential effects of aspirin on diseases such as Alzheimer's and cancer, which take a long time to develop before being recognized and treated.

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What are the current guidelines on aspirin? Will they change?

The most recent US Preventive Services Task Force guidelines indicate that there is "insufficient" evidence regarding the advantages and disadvantages of starting aspirin in people over 69 who have not Never For those between the ages of 60 and 69, the decision to start taking low dose aspirin should be discussed by each patient with their doctor, and this will depend on the risk of bleeding and other factors . For people aged 50 to 59 who are at risk for heart disease, low-dose daily aspirin is usually recommended.

These guidelines will not necessarily change. But new research findings suggest that among healthy adults over the age of 69, there may be enough evidence to recommend not starting low-dose aspirin.

Does this mean that I should stop taking aspirin?

No. Remember that this new research only applies to a small group of people who take aspirin daily. Medicine is applied one patient at a time and the guidelines are just guidelines: they do not apply to everyone. Talk to your doctor before making a decision about whether to start or stop taking aspirin.

Dr. Nicky Mehtani is a physician in internal medicine at Johns Hopkins Hospital and is part of the ABC News Medical Unit.