- For many years, doctors have recommended a daily low-dose aspirin to reduce the risk for heart attacks, strokes, cancer and other health problems.
- A new study alleges that common practice has no benefit for healthy older adults, instead reporting an increased risk of mortality from all causes for those taking aspirin compared to a placebo group.
- Although there still may be a benefit for those with a history of cardiac ailments, the medical community is now faced with a recommendation change in the accepted practice.
“Sometimes the ugly facts slay a good theory,” reported Sanjay Gupta, MD for CNN, quoting the author of a major new study that contradicts long-term medical recommendations promoting the heart- healthy benefits of a daily low-dose of aspirin.1
For many years, conventional medicine has maintained that a daily baby or low-dose aspirin helps older patients reduce their risk of heart attack, stroke, cancer and possibly dementia.2 In a surprise result, the Aspirin in Reducing Events in the Elderly (ASPREE) trial revealed not only that a daily low-dose aspirin did not improve disability-free survival among healthy older adults but also showed that the practice was associated with a “numerically higher rate of the secondary end point of death from any cause” compared with placebo.3
The Australian study, conducted to evaluate the veracity of the long-standing recommendation of a daily low-dose aspirin for older adults, enrolled 19,114 relatively healthy people from Australia and the United States. Participants were randomly assigned to receive 100 mg daily of aspirin or a matching placebo.
The study, which began in 2010, was halted on June 12, 2017 by the National Institute on Aging, which funded the trial. The reason given for the early close was that interim results clearly indicated that continuing the study would not improve the benefit in terms of the primary end point. Of the 1,052 deaths that occurred during the median 4.7 years of follow-up, cancer was the major factor in the higher mortality seen in the aspirin group compared with the placebo group (3.1 percent versus 2.3 percent cancer-related deaths in the two groups, respectively).
The researchers noted that a daily baby aspirin is still recommended for many who have already had a heart attack or stroke, and may be helpful for those under age 70 with a 10 percent or greater risk of having a heart attack. But, says Murray, for healthy older people, “the risks outweigh the benefits for taking low-dose aspirin.”4
Citing both strengths of the trial (such as the size of the study group, the number of subjects older than 70 and the abundant availability of background data on the participants) and weaknesses (primarily the limited follow-up period), the researchers concluded that the results should be interpreted with caution.5 Nevertheless, Dr. Gupta stated that he believes the unexpected results of the study will “change how doctors recommend things to their patients.”
It turns out the science was not settled about aspirin, after all.
1 Tinker B. With Daily Low-Dose Aspirin Use, Risks May Outweigh Benefits for Older Adults. CNN Sept. 17, 2018.
2 Stein R. Study: A Daily Baby Aspirin Has No Benefit For Healthy Older People. NPR Sept. 16, 2018.
3 McNeil JJ, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med Sept. 16, 2018.
4 See Footnote 2.
5 See Footnote 3.