David Poon, BSc Immunology and Infection, PharmD Student
Aspirin a Day Keeps the Doctor Away.
Or so we thought. For many years now, it was thought that taking a low dose aspirin may help prevent an initial heart attack or stroke. And at some point in time, it became the norm that just about anyone you would call elderly would take a baby aspirin a day to prevent strokes. Why? Because it was cheap, fairly safe, and far outweighed the risks of not doing it. However, that paradigm may be changing with the release of the ASPREE Study that included almost 20-thousand people aged 65 and over from the United States and Australia. These participants were deemed healthy and had no history of cardiovascular disease, dementia or disability. Half of the participants received aspirin 100 mg and the other half of participants received placebo for 5 years. The goal of this study was to find out if the risks outweighed the benefits of taking aspirin daily. The authors of the study discovered 3 major conclusions.
Higher Mortality in Those Taking Aspirin 100 mg Once Daily.1
In North America, the typical dose of a baby aspirin is 81 mg. The difference in dose is likely due to 100 mg aspirin being the standard dose in Australia. Nonetheless, results from the study may still be applicable to those living in North America. The first major conclusion the authors made was that there was no difference in mortality in those taking aspirin or placebo. In fact, mortality was slightly higher in those taking aspirin, although those results are not statistically significant. Interestingly, there was a higher incidence of mortality due to colorectal cancer in those taking aspirin compared to placebo.
No Difference In Disability-Free Survival.2
Disability-free survival was defined as survival following a stroke, free from dementia or physical disability. The rates of dementia or physical disability were similar in those taking aspirin or placebo. This meant that taking aspirin daily doesn’t help prevent dementia or other physical disabilities.
Increased Risk of Bleeding.3
Low dose aspirin acts as an antiplatelet medication. What does this mean? In our body, platelets are substances that naturally stop bleeding by clumping together in areas of damage. However, in individuals who are of greater age or who have certain medical conditions, there’s a greater chance that clots can form when they’re not supposed to. When this happens in the heart or brain, it may cause a heart-attack or stroke. Therefore, by preventing platelet aggregation, aspirin can prevent both of these. Unfortunately, the tradeoff is; theoretically, there’s an increased chance of bleeding from any cause. In the study we’ve been talking about, there was, in fact, a greater amount of bleeding within the gastrointestinal tract and brain from participants taking aspirin compared to those taking placebo.
The Bottom Line.
The bottom line is that taking aspirin daily does have a benefit, but it’s not for everyone. If you’re over the age of 65 taking daily aspirin and have never had a heart attack or stroke, the benefits may not outweigh the risk, and you may want to speak to your healthcare professional. However, if you’ve already had a history of cardiovascular problems and were prescribed aspirin, it’s important to stay on it to stay protected. Like with all medications, it’s important to speak to your healthcare professional when starting or stopping a drug – or if you have any questions at all!
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- McNeil John J., Nelson Mark R., Woods Robyn L., Lockery Jessica E., Wolfe Rory, Reid Christopher M., Kirpach Brenda, Shah Raj C., Ives Diane G., Storey Elsdon, Ryan Joanne, Tonkin Andrew M., Newman Anne B., Williamson Jeff D., Margolis Karen L., Ernst Michael E., Abhayaratna Walter P., Stocks Nigel, Fitzgerald Sharyn M., Orchard Suzanne G., Trevaks Ruth E., Beilin Lawrence J., Donnan Geoffrey A., Gibbs Peter, Johnston Colin I., Radziszewska Barbara, Grimm Richard, Murray Anne M.. (2018) Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med DOI: 10.1056/NEJMoa1803955.
- McNeil John J., Woods Robyn L., Nelson Mark R., Reid Christopher M., Kirpach Brenda, Wolfe Rory, Storey Elsdon, Shah Raj C., Lockery Jessica E., Tonkin Andrew M., Newman Anne B., Williamson Jeff D., Margolis Karen L., Ernst Michael E., Abhayaratna Walter P., Stocks Nigel, Fitzgerald Sharyn M., Orchard Suzanne G., Trevaks Ruth E., Beilin Lawrence J., Donnan Geoffrey A., Gibbs Peter, Johnston Colin I., Ryan Joanne, Radziszewska Barbara, Grimm Richard, Murray Anne M.. (2018) Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med DOI: 10.1056/NEJMoa1800722.
- 3. McNeil John J., Wolfe Rory, Woods Robyn L., Tonkin Andrew M., Donnan Geoffrey A., Nelson Mark R., Reid Christopher M., Lockery Jessica E., Kirpach Brenda, Storey Elsdon, Shah Raj C., Williamson Jeff D., Margolis Karen L., Ernst Michael E., Abhayaratna Walter P., Stocks Nigel, Fitzgerald Sharyn M., Orchard Suzanne G., Trevaks Ruth E., Beilin Lawrence J., Johnston Colin I., Ryan Joanne, Radziszewska Barbara, Jelinek Michael, Malik Mobin, Eaton Charles B., Brauer Donna, Cloud Geoff, Wood Erica M., Mahady Suzanne E., Satterfield Suzanne, Grimm Richard, Murray Anne M.. (2018) Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med DOI: 10.1056/NEJMoa1805819.