Costs of daily aspirin may outweigh benefits for older adults, study finds

Ben Davidson
September 20, 2018

The study titled ASPREE (Aspirin in Reducing Events in the Elderly) trial, appeared in the latest issue of the journal New England Journal of Medicine.

This protective capacity of aspirin was extrapolated to people who were otherwise healthy to prevent a first heart attack or stroke, despite the evidence supporting this to be sparse.

Aspirin has always been recommended for middle-aged folks with a history of heart disease, to prevent future heart attacks or strokes.

The use of aspirin by healthy people over 70 had no real impact on a person's likelihood to suffer from heart disease, dementia, stroke, cancer, or physical disability, the study found.

"We found there was no discernible benefit of aspirin on prolonging independent, healthy life for the elderly", said Murray, who is a geriatrician and epidemiologist at Hennepin Healthcare in Minneapolis.

Aspirin is not recommended for people who are pregnant or breastfeeding, have an active or previous stomach ulcer, or have a medical condition associated with bleeding.

While US Preventive Services Task Force guidelines on aspirin use, among other global guidelines, recommend a daily dose to prevent cardiovascular disease between the age of 50 and 69, a lack of available research meant this recommendation was not extended to people older than 70.

A large clinical trial involving participants in Australia and the US found a daily low-dose aspirin had no effect on prolonging life in healthy, elderly people. The Australian component of the study also received funding from the Australian National Health and Medical Research Council and Monash University.

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Lead researcher Professor John McNeil, of Monash University, Australia, said the findings show many older people may be taking the medicine "unnecessarily". However, the higher death rate was due to more cancer deaths in the aspirin group, which could have been due to chance, the researchers said. ASPREE has provided this answer.

Experts and current guidelines recommended a daily aspirin is most beneficial for adults in their 50s who are at risk of heart disease.

"It has been obvious since the 1990s that there was a need for a trial of aspirin for primary prevention in people age 70 and over". About half of them took 100 milligrams of aspirin daily (slightly more than a baby aspirin, which has 81 milligrams) and the other half were given a placebo.

The group taking aspirin had an increased risk of death compared to the placebo group: 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. They were followed for an average of close to five years.

But 3.8% of the aspirin takers experienced serious bleeding, compared with 2.8% of the placebo group. "The authors rightly suggest treating the unexpected effects with caution, but they also show that benefits of aspirin in healthy people are at best limited, and may well be harmful, and this harm may be increased beyond age 73".

The study also discovered an increase in deaths from cancer, although the researchers think this needs further investigation as it goes against current findings in the field.

"So in terms of people previously well ... the evidence has come in and clearly shown that there is no benefit, and in fact, it can create secondary other issues which are obviously of concern".

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