Aspirin late in life? Healthy people may not need it

Should older people in good health start taking aspirin to prevent heart attacks, strokes, dementia and cancer?

No, according to a study of more than 19,000 people, including whites 70 and older, and blacks and Hispanics 65 and older. They took low-dose aspirin — 100 milligrams — or a placebo every day for a median of 4.7 years. Aspirin did not help them — and may have done harm.

Taking it did not lower their risks of cardiovascular disease, dementia or disability. And it increased the risk of significant bleeding in the digestive tract, brain or other sites that required transfusions or admission to the hospital.

The results were published Sunday in three articles in The New England Journal of Medicine.

One disturbing result puzzled the researchers because it had not occurred in previous studies: a slightly greater death rate among those who took aspirin, mostly because of an increase in cancer deaths — not new cancer cases, but death from the disease. That finding needs more study before any conclusions can be drawn, the authors cautioned.

The researchers had expected aspirin would help prevent heart attacks and strokes in the study participants, so the results came as a surprise — “the ugly facts which slay a beautiful theory,” the leader of the study, Dr. John McNeil, of the department of epidemiology and preventive medicine at Monash University in Melbourne, Australia, said in a telephone interview.

Although there is good evidence aspirin can help people who have already had heart attacks or strokes, or who have a high risk that they will occur, the drug’s value is actually not so clear for people with less risk, especially older ones.

The newest findings apply only to people just like those in the study: in the same age ranges, and with no history of dementia, physical disability, heart attacks or strokes. In addition, most did not take aspirin regularly before entering the study.

The message for the public is that healthy older people should not begin taking aspirin.

“If you don’t need it, don’t start it,” McNeil said.

But those who have already been using it regularly should not quit based on these findings, he said, recommending they talk to their doctors first.