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A daily dose of aspirin? It is not a good idea if you are a healthy older adult.
A trio of studies based on a large-scale clinical trial shows that the drug does not help prevent heart attacks, strokes, dementia or physical disabilities. In fact, older people who took a low dose of aspirin a day were more likely to suffer severe internal bleeding than those who took a placebo. The researchers even observed more deaths among those on aspirin, although this result was not statistically significant.
The clinical trial, called ASPREE or Aspirin in reducing events in the elderly, included more than 19,000 adults. About half of these adults were randomly assigned to take 100 milligrams of aspirin a day and the other half a placebo tablet for about five years.
The articles, published online in the New England Journal of Medicine September 16, "Let's remember once again that aspirin is not a benign drug," says cardiologist Jeffrey Berger of New York University's Faculty of Medicine, who did not participate in the research.
"There is a lot of misunderstanding of the original data in support of aspirin," he says. According to Mr. Berger, the notion that any older person should take aspirin to prevent a first heart attack or stroke, "has not been born of evidence to date". who have not reported a history of cardiovascular disease were taking regular aspirin.
Here are some of the key findings of the new studies, as well as common confusion about the medical orientation of taking aspirin.
Does aspirin protect against heart attacks?
Yes, if you have ever had a heart attack or stroke or coronary heart disease. "If you've had a heart attack, it's not questionable: aspirin saves lives," Berger says. Clinical trials have shown that low-dose aspirin significantly reduces subsequent heart attacks and strokes in these patients, which equates to about 10 to 20 fewer of these events per 1,000 people per year. This advantage outweighs the increases seen in cases of internal bleeding.
What's not settled is if aspirin can help prevent first heart attack or stroke in people without cardiovascular disease, and the new work casts further doubt. Official recommendations are also mixed. The latest guidelines from the US Task Force on Preventative Services, dating from 2016, recommend to people aged 50 to 59 who are at least 10% risk of developing cardiovascular disease to take up to 100 mg of aspirin a day. The organization also finds evidence that the dose may be slightly beneficial for those 60 to 69 years old with the same risk of cardiovascular disease. But the US Food and Drug Administration does not support the use of aspirin to prevent a first heart attack or stroke, citing lack of evidence.
Anne Murray, a geriatrician and medical director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis, and her colleagues wanted to study whether aspirin was helpful in preventing cardiovascular disease in the elderly. The researchers' trial included Australians and Americans aged 70 and over, with black and Hispanic American participants aged 65 and over, although most participants were white.
Rates of cardiovascular disease, including heart attacks and strokes, were about the same between the aspirin and placebo groups: 10.7 events per 1,000 people per year and 11.3 events per 1,000 people receiving the placebo. But those taking aspirin were significantly more likely to develop major hemorrhage or hemorrhage in the stomach, intestines, or brain, with 8.6 events per 1,000 people compared to 6.2 events for 1,000 people from the placebo.
Why did the researchers also study dementia and disability?
"These are the two things that play the biggest role in people's ability to stay independent" in their senior years, says Murray. Her colleagues and she thought that the anticoagulant and anti-inflammatory properties of aspirin could reduce the risk of dementia and physical disability by improving small vessel diseases or abnormalities of the small blood vessels of the brain related to disturbances of thought and movement. .
But this hypothesis did not materialize. The combined rates of dementia, physical disability, and death were almost the same between the aspirin and placebo groups: 21.5 events versus 21.2 events per 1,000 people per year, respectively.
"There's really no measurable benefit of taking low-dose aspirin for healthy seniors," Murray says. "Certainly, the benefits do not offset the risk of bleeding."
Does not aspirin reduce the risk of certain cancers?
Yes, for colorectal cancer. Long-term aspirin, especially since 10 years, reduces the risk of this cancer, according to many studies. The US Preventative Services Task Force recommends aspirin for people aged 50-59 to prevent colorectal cancer.
Surprisingly, in the new work, "we found that cancer accounted for the highest proportion of people who died," among those in the aspirin group, says Murray. "It was unexpected, and we do not understand why." The trial did not reveal that aspirin increased or reduced the risk of cancer in healthy older adults.
Researchers want to study the use of aspirin in these older adults for another five years to see if longer-term use provides cancer protection in this age group and, if so, whether risk is greater than the risk of internal bleeding.
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