Daily aspirin may involve more risk than reward

Ben Davidson
September 18, 2018

The Monash University-lead ASPREE (ASPirin in Reducing Events in the Elderly) trial, involving more than 19,000 patients in Australia and the U.S., found that one 100mg aspirin a day did not prolong life free of disability, and did not significantly reduce the risk of a first heart attack or stroke among healthy participants.

Those who do not have a risk of heart disease or dementia, suffered a stroke, or have a "persistent physical disability", are at greater risk of suffering a bleed due to taking aspirin daily and are not proactively prolonging their lives by using it as a preventative measure. "Unless the cardiovascular risk is very high ( 20% over ten years), prophylactic aspirin results in more harm than good".

Until now, the balance between risks and benefits in older individuals was unclear, said Dr McNeil.

In the meantime, experts are warning against healthy people simply popping an aspirin every day and believing it will fix everything that ails them.

Researchers at Monash University in Australia recruited almost 20,000 people in that country and the United States, with a median age of 74. The researchers then followed the study's participants for a median of 4.7 years.

The results from the trial, published Sunday in three studies in the New England Journal of Medicine, show that the rate of cardiovascular disease was 10.7 events per 1,000 person-years in the aspirin group and 11.3 events per 1,000 person-years in the placebo group. It was called the Aspirin in Reducing Events in the Elderly (ASPREE) trial.

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Participants took either aspirin or a placebo daily over a four-and-a-half year period. "Particularly bleeding, which is more common in older people". However, studies in younger people showed that the risks outweighed the benefits and the new research confirms that the same is true for the elderly.

McNeil added it was important to focus on this cohort because aspirin is used by healthy, older people in the hopes that it will keep them well, with some even taking it without a prescription from their physician.

Scientists at Monash University in Australia enrolled 19,114 people aged 65 and older in Australia and the USA, randomly giving them a daily low-dose aspirin or a placebo.

And what about people with high blood pressure or high cholesterol who might be taking other medicines to mitigate a higher risk of heart attack or stroke? For adults 60 to 69, the task force recommended the decision should be made on a case-by-case basis. For people older than 70, the task force says it does not have enough information.

Instead, there was a slight increase in the incidence of serious bleeding: 3.8% in the aspirin group and 2.8% in the placebo group.

They found that the rates for major cardiovascular events, which including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke, were similar in both groups. "But not only did it not decrease risk of disability or death, it did not decrease the risk of heart attack and stroke, and there was an increase in the rate of death".

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