Aspirin late in life? Healthy people might 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 risks of cardiovascular disease, dementia or disability. And it increased the risk of signif- icant bleeding in the diges- tive tract, brain or other sites that required transfusions or admission to the hospital.
The results were published Sunday in The New England Journal of Medicine.
One disturbing result puz- zled 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. Scientists do not know what to make of it, particularly because earlier studies had suggested that aspirin could lower the risk of colorectal cancer.
The resear c he r s had expected aspirin would help prevent heart attacks and strokes in the study partic- ipants, 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.
The news may also come as a shock to millions of people who have been dutifully swal- lowing their daily pills like a magic potion to ward off all manner of ills. Although there is good evidence that 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 report is the latest in a recent spate of clinical tri- als that have been trying to determine who really should take aspirin. One study pub- lished in August found no benefit in low-risk patients. Another found that aspirin could prevent cardiovascular events in people with dia- betes, but that the benefits were outweighed by the risk of major bleeding.
A third study found that dose matters, and that heavier people might require more aspirin to prevent heart attacks, strokes and cancer.
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 disabil- ity, heart attacks or strokes. (Blacks and Hispanics were included in the study at a younger age than whites because they have higher risks than do whites for dementia and cardiovascular disease.) In addition, most did not take aspirin regularly before entering the study.
The message for the pub- lic is that healthy older people should not begin taking aspirin. But those who have already been using it regularly should not quit based on these findings, he said, recommending that they talk to their doctors first.
McNeil also emphasized that the new findings do not apply to people who have already had heart attacks or strokes, which usually involve blood clots. Those patients need aspirin, because it inhib- its clotting.
The study, named Aspree, is important because it addresses the unanswered question of whether healthy older people should take aspirin, said Dr. Evan Had- ley, director of the division of geriatrics and gerontology at the National Institute on Aging, which helped pay for the research. The National Cancer Institute, Monash University and the Australian government also paid. Bayer provided aspirin and placebos, but had no other role.