Breaking News
May 3, 2019 - Vaping and Smoking May Signal Greater Motivation to Quit
May 3, 2019 - Dementia looks different in brains of Hispanics
May 3, 2019 - Short-Staffed Nursing Homes See Drop In Medicare Ratings
May 3, 2019 - Study of teens with eating disorders explores how substance users differ from non-substance users
May 3, 2019 - Scientists develop new video game that may help in the study of Alzheimer’s
May 3, 2019 - Arc Bio introduces Galileo Pathogen Solution product line at ASM Clinical Virology Symposium
May 3, 2019 - Cornell University study uncovers relationship between starch digestion gene and gut bacteria
May 3, 2019 - How to Safely Use Glucose Meters and Test Strips for Diabetes
May 3, 2019 - Anti-inflammatory drugs ineffective for prevention of Alzheimer’s disease
May 3, 2019 - Study tracks Pennsylvania’s oil and gas waste-disposal practices
May 3, 2019 - Creating a better radiation diagnostic test for astronauts
May 3, 2019 - Vegans are often deficient in these four nutrients
May 3, 2019 - PPDC announces seed grants to develop medical devices for children
May 3, 2019 - Study maps out the frequency and impact of water polo head injuries
May 3, 2019 - Research on Reddit identifies risks associated with unproven treatments for opioid addiction
May 3, 2019 - Good smells may help ease tobacco cravings
May 3, 2019 - Medical financial hardship found to be very common among people in the United States
May 3, 2019 - Researchers develop multimodal system for personalized post-stroke rehabilitation
May 3, 2019 - Study shows significant mortality benefit with CABG over percutaneous coronary intervention
May 3, 2019 - Will gene-editing of human embryos ever be justifiable?
May 3, 2019 - FDA Approves Dengvaxia (dengue vaccine) for the Prevention of Dengue Disease in Endemic Regions
May 3, 2019 - Why Tonsillitis Keeps Coming Back
May 3, 2019 - Fighting the opioid epidemic with data
May 3, 2019 - Maggot sausages may soon be a reality
May 3, 2019 - Deletion of ATDC gene prevents development of pancreatic cancer in mice
May 2, 2019 - Targeted Therapy Promising for Rare Hematologic Cancer
May 2, 2019 - Alzheimer’s disease is a ‘double-prion disorder,’ study shows
May 2, 2019 - Reservoir bugs: How one bacterial menace makes its home in the human stomach
May 2, 2019 - Clinical, Admin Staff From Cardiology Get Sneak Peek at Epic
May 2, 2019 - Depression increases hospital use and mortality in children
May 2, 2019 - Vicon and NOC support CURE International to create first gait lab in Ethiopia
May 2, 2019 - Researchers use 3D printer to make paper organs
May 2, 2019 - Viral infection in utero associated with behavioral abnormalities in offspring
May 2, 2019 - U.S. Teen Opioid Deaths Soaring
May 2, 2019 - Opioid distribution data should be public
May 2, 2019 - In the Spotlight: “I’m learning every single day”
May 2, 2019 - 2019 Schaefer Scholars Announced
May 2, 2019 - Podcast: KHN’s ‘What The Health?’ Bye-Bye, ACA, And Hello ‘Medicare-For-All’?
May 2, 2019 - Study describes new viral molecular evasion mechanism used by cytomegalovirus
May 2, 2019 - SLU study suggests a more equitable way for Medicare reimbursement
May 2, 2019 - Scientists discover first gene involved in lower urinary tract obstruction
May 2, 2019 - Researchers identify 34 genes associated with increased risk of ovarian cancer
May 2, 2019 - Many low-income infants receive formula in the first few days of life, finds study
May 2, 2019 - Global study finds high success rate for hip and knee replacements
May 2, 2019 - Taking depression seriously: What is it?
May 2, 2019 - With Head Injuries Mounting, Will Cities Put Their Feet Down On E-Scooters?
May 2, 2019 - Scientists develop small fluorophores for tracking metabolites in living cells
May 2, 2019 - Study casts new light into how mothers’ and babies’ genes influence birth weight
May 2, 2019 - Researchers uncover new brain mechanisms regulating body weight
May 2, 2019 - Organ-on-chip systems offered to Asia-Pacific regions by Sydney’s AXT
May 2, 2019 - Adoption of new rules drops readmission penalties against safety net hospitals
May 2, 2019 - Kids and teens who consume zero-calorie sweetened beverages do not save calories
May 2, 2019 - Improved procedure for cancer-related erectile dysfunction
May 2, 2019 - Hormone may improve social behavior in autism
May 2, 2019 - Alzheimer’s disease may be caused by infectious proteins called prions
May 2, 2019 - Even Doctors Can’t Navigate Our ‘Broken Health Care System’
May 2, 2019 - Study looks at the impact on criminal persistence of head injuries
May 2, 2019 - Honey ‘as high in sugars as table sugar’
May 2, 2019 - Innovations to U.S. food system could help consumers in choosing healthy foods
May 2, 2019 - FDA Approves Mavyret (glecaprevir and pibrentasvir) as First Treatment for All Genotypes of Hepatitis C in Pediatric Patients
May 2, 2019 - Women underreport prevalence and intensity of their own snoring
May 2, 2019 - Concussion summit focuses on science behind brain injury
May 2, 2019 - Booker’s Argument For Environmental Justice Stays Within The Lines
May 2, 2019 - Cornell research explains increased metastatic cancer risk in diabetics
May 2, 2019 - Mount Sinai study provides fresh insights into cellular pathways that cause cancer
May 2, 2019 - Researchers to study link between prenatal pesticide exposures and childhood ADHD
May 2, 2019 - CoGEN Congress 2019: Speakers’ overviews
May 2, 2019 - A new strategy for managing diabetic macular edema in people with good vision
May 2, 2019 - Sagent Pharmaceuticals Issues Voluntary Nationwide Recall of Ketorolac Tromethamine Injection, USP, 60mg/2mL (30mg per mL) Due to Lack of Sterility Assurance
May 2, 2019 - Screen time associated with behavioral problems in preschoolers
May 2, 2019 - Hormone reduces social impairment in kids with autism | News Center
May 2, 2019 - Researchers synthesize peroxidase-mimicking nanozyme with low cost and superior catalytic activity
May 2, 2019 - Study results of a potential drug to treat Type 2 diabetes in children announced
May 2, 2019 - Multigene test helps doctors to make effective treatment decisions for breast cancer patients
May 2, 2019 - UNC School of Medicine initiative providing unique care to dementia patients
May 2, 2019 - Nestlé Health Science and VHP join forces to launch innovative COPES program for cancer patients
May 2, 2019 - Study examines how our brain generates consciousness and loses it during anesthesia
May 2, 2019 - Transition Support Program May Aid Young Adults With Type 1 Diabetes
May 2, 2019 - Study shows how neutrophils exacerbate atherosclerosis by inducing smooth muscle-cell death
May 2, 2019 - Research reveals complexity of how we make decisions
Daily low-dose aspirin doesn’t reduce heart-attack risk in healthy people

Daily low-dose aspirin doesn’t reduce heart-attack risk in healthy people

For decades, doctors have been prescribing low-dose aspirin for healthy people over the age of 70. Credit: shutterstock.com

Taking low-dose aspirin daily doesn’t preserve good health or delay the onset of disability or dementia in healthy older people. This was one finding from our seven-year study that included more than 19,000 older people from Australia and the US.

We also found daily low-dose aspirin does not prevent heart attack or stroke when taken by elderly people who hadn’t experienced either condition before. However it does increase the risk of major bleeding.

It has long been established that aspirin saves lives when taken by people after a cardiac event such as a heart attack. And it had been apparent since the 1990s there was a lack of adequate evidence to support the use of low-dose aspirin in healthy older people. Yet, many healthy older people continued being prescribed aspirin for this purpose.

With the growing proportion of elderly people in our community, a major focus of preventive medicine is to maintain the independence of this age-group for as long as possible. This has increased the need to resolve whether aspirin in the healthy elderly actually prolongs their good health.

Published in the New England Journal of Medicine today, the ASPirin in Reducing Events in the Elderly (ASPREE) trial was the largest and most comprehensive clinical trial conducted in Australia. It compared the effects of aspirin and a placebo in people over the age of 70 without a medical condition that required aspirin.

Our findings mean millions of healthy people over the age of 70, and their doctors, will now know daily aspirin is not the answer to prolonging good health.

Why aspirin for prevention?

Aspirin was first synthesised in 1898. Since the 1960s it has been known that aspirin lowers the risk of heart attack and stroke among those who have had heart disease or stroke before. This is referred to as secondary prevention.

This effect has been attributed to aspirin’s ability to prevent platelets from clumping together and obstructing blood vessels – sometimes referred to as “thinning the blood”.

It had been assumed this protective action could be extrapolated to people who were otherwise healthy to prevent a first heart attack or stroke (known as primary prevention). A number of early primary prevention trials in middle-aged people appeared to confirm this view.

However more recent trials, including the ASCEND trial in diabetes and the ARRIVE trial in younger high-risk individuals, have thrown doubt on this proposition.

In older people, any effect of aspirin on reducing heart disease or stroke might be expected to be enhanced because of their higher underlying risk. But aspirin’s adverse effects (mainly bleeding) might also be increased as older people are at higher risk of bleeding.

The balance between risks and benefits in this age group was previously quite unclear. This was also recognised in various clinical guidelines for aspirin use, which specifically acknowledged the lack of evidence in people older than 70.

The ASPREE trial

A trial of aspirin in the elderly was first called for in the early 1990s. But since aspirin was off patent, there was little prospect of securing industry funding to support a large trial. But controversy arising around the use of aspirin for primary prevention in the mid 2000s led to Monash University receiving initial funding from the National Health and Medical Research Council.

Funding in Australia was only a part of that required to establish a trial the size and complexity of ASPREE. A grant from the US National Institute on Ageing (and subsequently from the US National Cancer Institute) made the study become feasible.

Another challenge was recruiting the necessary thousands of older volunteers who were healthy and living and often working in their community. Unlike most studies, we required participants who weren’t in hospital or sick.

This was addressed with the assistance of more than 2,000 GPs who collaborated with the research team supporting recruitment of their patients and overseeing their health. In Australia, 16 sites were established across south-eastern Australia, Tasmania, Victoria, the ACT and southern NSW, to localise study activity and host community events that kept our volunteers updated and involved.

ASPREE is the first major prevention trial to use disability-free survival as the primary health measure. Disability-free survival provides a single integrated measure of whether an intervention such as aspirin provides net benefit. The rationale is that there is little point for elderly people to be taking a preventive medication unless it preserves good health and unless benefits of the medication outweigh any adverse effects.

Large-scale preventive health studies like ASPREE will become increasingly important to help keep an ageing population fit, healthy, out of hospital and living independently. As new preventive opportunities arise they will typically require large clinical trials, and the structure of the Australian health system has proven an ideal setting for this type of study.

Other results from the ASPREE trial will continue to appear for some time. These will describe longer-term effects of daily low dose aspirin on issues such as dementia and cancer. It will also provide valuable information about other strategies to promote healthy ageing well into the future.


Explore further:
Daily low-dose aspirin found to have no effect on healthy life span in older people

Journal reference:
New England Journal of Medicine

Provided by:
The Conversation

Tagged with:

About author

Related Articles