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Risks of daily aspirin outweigh benefits for healthy older adults

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Taking a daily dose of aspirin does not prolong healthy living in older adults who have not previously experienced a cardiovascular event, according to an international trial.

The study findings question to idea of using aspirin for so-called cardiovascular primary prevention in older people, with the risk of bleeding caused by the drug outweighing any benefits.

“The results will have a significant impact on guidelines about aspirin use for prevention”

Raj Shah

Daily doses of aspirin have been heralded for reducing risk of cardiovascular disease and are often prescribed for those who have suffered a stroke – known as secondary prevention.

Aspirin thins the blood and reduces risk of the recurrence of a stroke. However, not only those who have suffered a stroke take daily doses of aspirin due to ideas on primary prevention.

But the new study published in a major US journal has revealed that daily aspirin has no benefit for healthy older adults without cardiovascular disease and may be more dangerous than helpful.

The New England Journal of Medicine published three papers on a study that began in 2010. It monitored 19,114 people aged over 70, testing the benefits of aspirin on healthy adults from Australia and the US.

The ASPirin in Reducing Effects in the Elderly (ASPREE) trial’s primary end point was to determine if aspirin, taken over the span of at least five years, would extend disability-free life in already healthy senior adults.

ASPREE found that there were no benefits for the study participants who were taking aspirin compared to those who were given a placebo pill.

ASPREE also weighed the potential benefit of prevention of cardiovascular disease to the proven increased risk of bleeding in the brain and gastrointestinal tract.

The results showed that the risk of bleeding was increased – clinically significant bleeding occurring in 3.8% of people on aspirin and 2.7% of those with a placebo. However, the risk of cardiovascular disease was not significantly reduced, said the researchers.

In addition, the trial found that taking aspirin daily did not reduce the occurrence of dementia or physical disability. Among the people taking aspirin, 90.3% remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5% of those taking a placebo.

Overall, the group taking aspirin had an increased risk of death compared to the placebo group, with 5.9% of participants taking aspirin and 5.2% taking placebo died during the study.

The increased risk of death when taking aspirin was primarily due to an increased occurrence of cancer, said the researchers. However, the researchers noted that any connection between cancer risk and aspirin was unknown and required further study.

They stated that the main concern for consuming aspirin daily remained the increased risk of haemorrhaging, without the benefits of decreased risk of cardiovascular disease in healthy people.

Dr Raj Shah, principal investigator in the ASPREE trial, said: “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.”

Continued research will be undertaken by the ASPREE team to determine more of aspirin’s effects on dementia, cancer, and cardiovascular disease.

“Continuing follow-up of the ASPREE participants is crucial, particularly since longer term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date,” said Dr Evan Hadley, from the US National Institute on Aging, which supported the trial.

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