Will Healthy Seniors Benefit From Daily Aspirin?
Daily low-dose aspirin is recommended for heart attack survivors or people at increased risk, but up to now experts have discouraged the practice for aging individuals in good health.
Now, a new evidence review suggests that some healthy seniors and middle-aged adults might gain a bit of benefit from taking daily aspirin.
Low-dose aspirin decreases the risk of heart attack and stroke risk even in those without any heart health problems, British researchers report.
However, the protective effect is "quite small," and carries with it an increased risk of serious bleeding, said lead researcher Dr. Sean Zheng.
"For a combination of heart attack, stroke and cardiovascular death, 265 people need to be treated for five years to prevent one event," said Zheng, an academic clinical fellow with King's College Hospital NHS Foundation Trust in London.
"However, for every 210 patients treated with aspirin, one would suffer a major bleed episode," he said.
The upshot? Anyone thinking about taking aspirin to protect their heart health should talk it over with their doctor, said Donna Arnett. She is past president of the American Heart Association and dean of the University of Kentucky College of Public Health.
"Because of this benefit-to-harm aspect of aspirin, there is no straightforward answer about who should be taking it," Arnett said.
"For aspirin use, it is very important for each patient to discuss with his/her health care provider about whether aspirin would benefit him/her," she said.
Aspirin thins the blood, and has long been recognized as a means of preventing blood clots that could cause a heart attack or stroke.
But by thinning blood, aspirin also increases your risk of bleeding. This could contribute to bleeding ulcers in the gastrointestinal system or even hemorrhagic strokes in the brain.
As a result, experts have limited daily low-dose aspirin use (usually 81 milligrams) to people who've already had a heart attack or stroke, or those at increased risk of such an event.
To see whether daily aspirin might benefit a broader range of people, Zheng and his colleagues gathered data from 13 clinical trials involving more than 164,000 people. Half were younger than 62, and half older.
The trial data showed that aspirin decreased the absolute risk of heart attack, stroke or death from heart disease by 0.38 percent, which is a statistically significant finding.
At the same time, aspirin increased the absolute risk of major bleeding by 0.47 percent.
"In those without cardiovascular disease, this study shows that really it is an individual decision regarding whether to take aspirin or not," Zheng said.
"It all depends on how the patient values prevention of cardiovascular events [heart attacks and strokes] over potentially serious bleeding [including intracranial]," he said.
Zheng and Arnett emphasized that this new analysis focused on healthy people who've never had a heart attack or stroke.
"Anyone who has known cardiovascular disease [for example, heart attacks, angina or strokes] and is on aspirin should almost certainly continue taking it," Zheng said. "This study did not look at this group, where the benefit of aspirin is unquestionable."
The findings are in the Jan. 22 Journal of the American Medical Association.
The U.S. Department of Health and Human Services has more on daily low-dose aspirin therapy.
SOURCES: Sean Zheng, B.M., B.Ch., M.A., M.R.C.P., academic clinical fellow, King's College Hospital NHS Foundation Trust, London; Donna Arnett, Ph.D., dean, University of Kentucky College of Public Health; Journal of the American Medical Association, Jan. 22, 2019