Daily aspirin won’t prevent heart disease, stroke or prolong life

Daily low-dose aspirin found to have no effect on prevention of major cardiovascular disease, stroke

A landmark trial has found that daily low-dose aspirin has no effect on prevention of major cardiovascular disease, stroke or prolonging healthy life span in older people. Aspirin, the blood thinning drug is prescribed to most patients with increased risk of clotting.

Risks and benefits of daily low-dose aspirin in healthy adults aged 70 and more were assessed  in a large clinical trial. Aspirin was not found to have significant beneficial effect on prevention of major cardiovascular diseases, heart attacks or stroke, and did not prolong healthy, independent living (life free of dementia or persistent physical disability).

A long standing dilemma regarding the benefits of initiating low dose aspirin in healthy older people to lower cardiovascular risks has been cleared by this trial.

The initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial were published in The New England Journal of Medicine.

The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain.

Non-communicable diseases such as stroke, heart disease and diabetes are responsible for 38 million deaths each year in India. Ischemic heart disease was the number one cause of death in 2016, according to the first Indian state level disease burden study released in 2017.

The trial began in 2010 and enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States) free of dementia, physical disability or free of medical conditions requiring aspirin use. Participants were followed for an average of 4.7 years to determine outcomes.

NIA Director Richard J. Hodes said, “The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. This study shows why it is so important to conduct this type of research, so that we can gain a fuller picture of aspirin’s benefits and risks among healthy older persons.”

Treatment with 100 mg of low-dose aspirin per day did not affect survival free of dementia or disability in the whole study population. Among the people randomly assigned to take aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo.

5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study.

The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance, suggested the researchers.

The rates for major cardiovascular events – including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.

The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain.

Clinically significant bleeding (hemorrhagic stroke – bleeding in the brain, bleeding in the abdomen or bleeding at other sites that required transfusion or hospitalization) occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking the placebo.

50 percent of the people who died in the trial had some type of cancer and investigators are continuing to analyse all cancer related data from the trial. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.

Evan Hadley, M.D., director of NIA’s Division of Geriatrics and Clinical Gerontology, said “These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants.”