Aspirin study: Warns risk outweighs benefits for some

Pittsburgh Post-Gazette

Don’t start taking baby aspirin on your own if you’re a healthy older adult. Instead, get back to eating right and getting enough sleep and exercise. And, of course, don’t forget to keep your blood pressure and cholesterol under control and get your cancer screenings.

The advice is supported by a large international study, which involved University of Pittsburgh researchers. It was published Sunday in the New England Journal of Medicine, reporting that low-dose aspirin taken daily by healthy older adults poses a risk of bleeding that outweighs any benefit in preventing heart attacks and strokes.

When starting the ASPREE trial, scientists expected that the benefits of aspirin in older people might be greater than what had been seen in younger people, according to one of the study leaders, John McNeil, head of the department of epidemiology and preventive medicine at Monash University in Melbourne, Australia.

“We were well aware the bleeding risk would also be higher,” he said. “Millions are taking aspirin around the world, without medical advice, without an idea of the risk and benefits. … We found that if you don’t need to take aspirin, the risk and balance is not favorable.”

The Pittsburgh arm of ASPREE — a randomized double-blind placebo-controlled trial that enrolled 19,114 people in Australia and the U.S. — was led by nationally recognized aging expert Anne Newman of Pitt. Participants were followed over an average of 4.7 years to see if aspirin could help them lead a longer, healthier life.

“Right now, there’s not a magic bullet,” Dr. Newman said, commenting on the results of testing daily doses of 100 milligram aspirin in adults 70 years old and up. The study was partially supported by the National Institutes of Health.

Starting in 2010, the study found the daily pill taken by half of the study participants did not affect the rates of surviving without dementia or disability: Rates were 90.3 percent when taking the aspirin and 90.5 percent for those taking a placebo.

However, the study reports 361 people who were on aspirin had hemorrhagic stroke, bleeding in the brain, bleeding in the gastrointestinal tract or elsewhere that called for a blood transfusion or hospitalization. Of those taking placebo, 265 had serious bleeding.

“It had to be a very large study to get an answer,” Dr. Newman said. “Now we have data to set prevention guidelines. People should not start taking aspirin without talking to their doctor. In the United States, a lot of people are taking aspirin on their own; it’s not related to the cardiovascular risk they have. As many as 30 percent of lowrisk people take aspirin.”

As people age, their risk for higher blood pressure and cholesterol goes up, along with a risk of bleeding, Dr. Newman said. She said earlier studies had not included people who were over 70, but the ASPREE results show aspirin poses a risk for significant bleeding that outweighs its prevention benefits.

When it came to major cardiovascular events, such as heart disease, nonfatal heart attacks and ischemic strokes, the study found the rates the two groups taking aspirin or placebo were similar. When taking aspirin, there were