Published on: 18-Sep-2018
Daily low-dose aspirin can be of help to older people with an elevated risk for a heart attack. But for healthy older people, the risk outweighs the benefit.
Many healthy Americans take a baby aspirin every day to reduce their risk of having a heart attack, getting cancer and even possibly dementia. But is itreally a good idea?
Results released Sunday from a major study of low-dose aspirin contain a disappointing answer for older, otherwise healthy people.
“We found there was no discernible benefit of aspirin on prolonging independent, healthy life for the elderly,” says Anne Murray, a geriatrician and epidemiologist at Hennepin Healthcare in Minneapolis, who helped lead the study.
The study involved more than 19,000 people ages 65 and older in the United States and Australia. The results were published in three papers in the New England Journal of Medicine.
There is still strong evidence that a daily baby aspirin can reduce the risk that many people who have already suffered a heart attack or stroke will suffer another attack.
And there is some evidence that daily low-dose aspirin may help people younger than 70 who have at least a 10 percent risk of having a heart attack avoid a heart attack or stroke, according to the latest recommendations from the U.S. Preventive Services Task Force.
But for older, healthy people, “the risks outweigh the benefits for taking low-dose aspirin,” Murray says.
The primary risk is bleeding. The study confirmed that a daily baby aspirin increases the risk for serious, potentially life-threatening bleeding.
Surprisingly, those who took daily aspirin also appeared to be more likely to die overall, apparently from an increased risk of succumbing to cancer. That was especially unexpected given previous evidence that aspirin might reduce the risk for colorectal cancer.
The researchers stressed, however, that the cancer finding might have been a fluke. There’s also a possibility that any colorectal cancer benefit wasn’t seen because the subjects had only been followed for about five years.
Regardless, the findings raise serious questions as to whether otherwise healthy older people should routinely take low-dose aspirin.
“A lot of people read, ‘Well, aspirin is good for people who have heart problems. Maybe I should take it, even if they haven’t really had a heart attack,’ ” Murray says. But “for a long time there’s been a need to establish appropriate criteria for when healthy people — elderly people — need aspirin.”
That’s why the researchers launched their study, called ASPREE, in 2010. It involved 19,114 older people, with 16,703 in Australia and 2,411 in the United States. The U.S. portion included white volunteers ages 70 and older, and African-Americans and Hispanics subjects ages 65 and older.
Participants took either 100 milligrams of aspirin every day or a placebo. People in the study were followed for an average of 4.7 years.
“We were hoping that an inexpensive, very accessible medication might be something that we could recommend to elderly to maintain their independence but also decrease their risk of cardiovascular disease,” Murray says.
But based on the findings, Dr. Evan Hadley of the National Institute on Aging, which helped fund the study, says any elderly people taking aspirin or thinking about it should think twice.
“This gives pause and a reason for older people and their physician to think carefully about the decision whether to take low-dose aspirin regularly or not,” Hadley says. “And in many cases the right answer may be: Not.”
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