Daily aspirin may be harmful for healthy, older adults, large study finds

Henrietta Brewer
September 19, 2018

The researchers did not state whether healthy older people who have been taking aspirin should stop.

"People aged over 45 with no known coronary heart disease will benefit most from a healthy lifestyle and seeing their doctor for risk assessments such as blood pressure, cholesterol and sugar levels", a spokesperson for the Heart Foundation said. Their findings were published Sunday in The New England Journal of Medicine. But when researchers looked at more than 19,000 people in Australia and the United States over almost five years, they found it wasn't so.

Researchers studied over 19,000 people 65 years old and older in the US and Australia.

It found that for older people with no history of heart attack, stroke or congestive heart failure taking a daily aspirin might do more harm than good.

The participants were randomly assigned to receive either 100 milligrams per day of aspirin or a placebo pill. Aspirin intake is associated with increased bleeding tendencies. In the aspirin group, 448 people experienced cardiovascular events compared with 474 people in the placebo group.

However the authors said the small increase in deaths, primarily from cancer, requires further investigation and may be coincidental. The new study was created to find out whether low-dose aspirin could prolong healthy, independent living in seniors who had not shown signs of heart disease.

"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 line of thinking is "well if it works to prevent a second heart attack or stroke, why wouldn't it prevent the first one?" said Dr. John McNeil, co-principal investigator of the trial and professor in the department of epidemiology and preventive medicine at Monash University in Australia. This may have implications for healthy, elderly people around the world who take low-dose aspirin without a medical reason. At worst, it may raise their risk of internal bleeding and early death.

Several years ago, many physicians floated the idea of using a regimen of low-dose daily aspirin to prevent cardiovascular diseases in the elderly.

The study looked at almost 20,000 people in the US and Australia for almost five years. "But for the people who decide to take aspirin just off their own bat, this research has cast some doubt over whether it is a good idea".

They found that the major haemorrhagic events suffered involved gastrointestinal (stomach and intestines) and intracranial (inside the skull) bleeding.

For healthy people, the study failed to show an overall benefit to offset the bleeding risk, he said.

Contrary to popular belief, an aspirin-a-day may not quite work as a preventive in older people who have not had a heart attack.

The participants weren't told whether they were taking aspirin or not.

As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer.

"The increase in cancer deaths in study participants in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes", Dr. Leslie Ford, associate director for clinical research in the National Cancer Institute's Division of Cancer Prevention, said. "Aspirin is a double-edged sword; it is absolutely essential drug and a lifesaver in patients with established heart disease (or arterial blockages) and many patients with diabetes where risk is high". In addition, the study did not address aspirin's effects in people younger than age 65.

Researchers also looked at whether taking aspirin affected the likelihood of developing dementia, but found little difference between those who took aspirin and those who took a placebo.

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