Breaking News
February 19, 2019 - Scientists untangle how microbes manufacture key antibiotic compound
February 19, 2019 - Greater primary care physician supply associated with longer life spans
February 19, 2019 - HIV-1 protein suppresses immune response more broadly than thought
February 19, 2019 - For 2020 Dem Hopefuls, ‘Medicare-For-All’ Is A Defining Issue, However They Define It
February 19, 2019 - KU professor discusses promise of brain-computer interface to aid, restore communication
February 19, 2019 - Early marker of cardiac damage triggered by cancer treatment identified
February 19, 2019 - Antidepressant drug could save people from deadly sepsis, research suggests
February 19, 2019 - CRISPR technology creates pluripotent stem cells that are ‘invisible’ to the immune system
February 19, 2019 - Midlife Systemic Inflammation Linked to Later Cognitive Decline
February 19, 2019 - Therapy derived from parasitic worms downregulates proinflammatory pathways
February 19, 2019 - Antimicrobial reusable coffee cups are less likely to become contaminated with bacteria, study shows
February 19, 2019 - Harnessing the evolutionary games played by cancer cells to advance therapies
February 19, 2019 - AHA News: Heart Transplant Survivor Gets Wedding Proposal at Finish Line
February 19, 2019 - HIV hidden in patients’ cells can now be accurately measured
February 19, 2019 - Research finds reasons for sudden cardiac death in patients with stable ischemic disease
February 19, 2019 - New protocol could help physicians to rule out bacterial infections in infants
February 19, 2019 - Women experiencing miscarriage should be offered treatment choices
February 19, 2019 - New protocol can help identify febrile infants at low risk for serious bacterial infections
February 19, 2019 - Innovative way to block HIV runs into a roadblock
February 19, 2019 - Springer Nature with BCRF conduct pilot project to make their research datasets more accessible
February 19, 2019 - Study finds neuromelanin-sensitive MRI as potential biomarker for psychosis
February 19, 2019 - Improvements in cardiovascular care for elderly save billions in health care costs
February 19, 2019 - Chilean food regulations are changing food perceptions and purchasing habits, study suggests
February 19, 2019 - Index endoscopy results are crucial for assessment of Barrett’s patients
February 18, 2019 - Breast cancer screening age should be lowered to 35
February 18, 2019 - Brain synchronization depends on the language of communication
February 18, 2019 - Drug Company Payments Over Time May Influence Rx Practices
February 18, 2019 - Despite socioeconomic gains, black-white ‘health gap’ remains
February 18, 2019 - Researchers report progress in the treatment of aggressive brain tumors
February 18, 2019 - Scientists discover trigger that turns strep infections into devastating disease
February 18, 2019 - Scanning children’s teeth may predict future mental health issues
February 18, 2019 - Health Highlights: Feb. 14, 2019
February 18, 2019 - New knowledge could help predict and prevent depression
February 18, 2019 - More primary care physicians leads to longer life spans | News Center
February 18, 2019 - Study examines link between supply of primary care physicians and life expectancy
February 18, 2019 - New study assesses screen time in young children
February 18, 2019 - Patented IU discovery to treat ARDS has been optioned to Theratome Bio
February 18, 2019 - Software found to be four times better at monitoring ovarian cancer
February 18, 2019 - Male Y chromosomes not ‘genetic wastelands’
February 18, 2019 - Hormone therapy during gender transition may increase risk for cardiovascular events
February 18, 2019 - NICE renews accreditation for Advanced
February 18, 2019 - FDA Grants Orphan Drug Designation to Amplyx Pharmaceuticals for APX001 for Treatment of Cryptococcosis
February 18, 2019 - Molecule effective in killing tuberculosis bacteria
February 18, 2019 - Columbia researchers unravel why some glioblastomas respond to immunotherapy
February 18, 2019 - Men who are able to do ten push-ups are less likely to have a stroke
February 18, 2019 - Blood-brain barrier disruption could lead to age-related cognitive decline
February 18, 2019 - Combination of PARP inhibitor and immunotherapy results in tumor regression in SCLC mouse models
February 18, 2019 - Heavy smoking could lead to vision loss, study finds
February 18, 2019 - New diagnostic test for malaria uses spit, not blood
February 18, 2019 - New therapeutic molecules show promise in reversing memory loss related to depression, aging
February 18, 2019 - Darla Shine joins anti-vaccination campaigners
February 18, 2019 - New study outlines sex-specific issues in ischemic heart disease
February 18, 2019 - Drug combinations could become first-line treatment for metastatic kidney cancer
February 18, 2019 - Lifetime adversity, increased neural processing during trauma combine to intensify core PTSD symptoms
February 18, 2019 - HRQoL Scores Decrease With Treatment Line in Multiple Myeloma
February 18, 2019 - Convincing evidence that type 2 diabetes is a cause of erectile dysfunction
February 18, 2019 - Study offers implications of advanced age in evaluation, management of ischemic heart disease
February 18, 2019 - Children from homes with flame-retardant sofa have high SVOC concentration in their blood
February 18, 2019 - Art Institute of Chicago announces results of research on five terracotta sculptures
February 18, 2019 - New PET/CT tracer shows high detection rate for diagnosis of acute venous thromboembolism
February 18, 2019 - Smoking may blight immune response against melanoma and reduce survival
February 18, 2019 - How Inactivity and Junk Food Can Harm Your Brain
February 18, 2019 - Diabetes tops common conditions for frequent geriatric emergency patients
February 18, 2019 - Longer-lived sperm produces offspring with healthier lifespans
February 18, 2019 - New dental adhesive prevents tooth decay around orthodontic brackets
February 18, 2019 - New eHealth tool shows potential to improve quality of asthma care
February 18, 2019 - New Australian initiative helps emergency clinicians to improve patient care
February 17, 2019 - Apellis Pharmaceuticals’ APL-2 Receives Fast Track Designation from the FDA for the Treatment of Patients with Paroxysmal Nocturnal Hemoglobinuria
February 17, 2019 - Researchers identify faulty ‘brake’ that interferes with heart muscle’s ability to contract and relax
February 17, 2019 - Support from trusted adults can reduce risk of dying in suicidal teens, finds study
February 17, 2019 - Heart attack awareness improved since 2008
February 17, 2019 - Exercise gives a better brain boost to older men than women
February 17, 2019 - New research disproves previous assumptions of how looks influence personality
February 17, 2019 - Cannabis use as a teenager linked to depression later in life
February 17, 2019 - Sinks by Toilets in ICU Patient Rooms Harbor Harmful Bacteria
February 17, 2019 - Cancer cells’ plasticity makes them harder to stop
February 17, 2019 - Young cannabis users have increased risk of depression and suicidal behavior
February 17, 2019 - Tasmanian Devils Likely to Survive Cancer Scourge
February 17, 2019 - Neoadjuvant PD-1 blockade seems effective in glioblastoma
February 17, 2019 - Personal, social factors play role in enabling sustainable return to work after ill health
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

image_pdfDownload PDFimage_print
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