A Daily Aspirin Doesn’t Prolong Life: Study
An aspirin a day may not keep the doctor away, according to a trio of studies published in the New England Journal of Medicine on Sept. 16. Instead, the Aspirin in Reducing Events in the Elderly (ASPREE) studies of nearly 20,000 people found a daily low-dose or baby aspirin regimen provides no significant health benefits for healthy older adults and could cause serious harm.
The primary study, a randomized, double-blind, plecebo-controlled trial — considereed the gold standard of clinical trials — included 16,703 people in Austrailia and 2,411 in the U.S. Caucasin participants were at least 70-years-old, while African American and Hispanic participants in the U.S. were at least 65-years-old because of their higher risk for dementia and cardiovascular disease. Half of the study participants received 100 milligrams of aspirin a day; the other half received a placebo. A typical “low-dose” aspirin contains 81 milligrams of the drug.
“This work is a key milestone in the more than a decade-long engagement in this large-scale clinical trial in the United States and Australia,” said Dr. Raj C. Shah, an associate professor of family medicine at the Rush Alzheimer’s Disease Center in Chicago. Shah was the principal investigator on the study at Rush University Medical Center. He also served as a member of the study’s international steering committee and as co-U.S. investigator.
“The results will have a significant impact on guidelines about aspirin use for prevention and in daily clinical conversations between clinicians and their older, healthy patients regarding whether aspirin should or should not be used for achieving disability-free longevity,” said Shah.
The study, which began in 2010, sought to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous heart problems, dementia or physical disability, and who were free of medical conditions requiring aspirin. The results showed that aspirin did not extend healthy independent living free of dementia or persistent physical disability.
After almost five years, researchers did not find a difference between the two groups when it came to “disability-free survival.” They did, however, document a higher rate of bleeding in the group that received aspirin, compared to the group that received a placebo. The second study found that “the risk of major hemorrhage was significantly higher with aspirin than with a placebo. Major hemorrhage events primarily involved upper gastrointestinal and intracranial bleeding.” And the third study saw “higher all-cause mortality … among apparently healthy older adults who received daily aspirin than among those who received [a] placebo and was attributed primarily to cancer-related death.” The authors added, “In the context of previous studies, this result was unexpected and should be interpreted with caution.”
Aspirin was associated with greater risk of bleeding
Of the people taking aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo. Rates of physical disability were similar, and rates of dementia were almost identical in both groups. Researchers also found that the rates for major cardiovascular events — including coronary heart disease, nonfatal heart attacks and strokes — were similar in both groups.
However, researchers noted that bleeding — a known risk of regular aspirin use — primarily in the gastrointestinal tract and brain, occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking a placebo.
Findings do not apply to patients with heart conditions
For patients with a history of heart attack or stroke, previous research is clear and has shown that the benefits of daily aspirin use outweigh the risks. The U.S. Preventive Services Task Force recommends “low-dose aspirin use for the primary prevention of cardiovascular disease and colorectal cancer in adults aged 50 to 59 years who have a 10 percent or greater” risk of cardiovascular disease. Over age 60 the task force is less prescriptive.
“Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease,” said National Institute of Aging (NIA) director Dr. Richard J. Hodes. “The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions.”
Consult your doctor before discontinuing aspirin
According to the studies, taking a low-dose aspirin daily is, at best, a waste of money for healthy older adults. At worst, it may increase their risk of internal bleeding and early death. The researchers are not recommending that if you are healthy and taking daily aspirin you should stop.
“These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned,” cautioned Dr. Evan Hadley, director of the NIA’s Division of Geiratrics and Clinical Gerontology.
He emphasized that older adults should follow the advice of their physicians about daily aspirin use. The new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin’s effects in people younger than age 65. Also, since only 11 percent of participants had regularly taken low-dose aspirin prior to entering the study, the implications of the findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue or discontinue use.
Rush University Medical Center contributed to this article