Many healthy Americans take a baby aspirin every day to reduce their risk of having a heart attack, getting cancer and even possibly dementia. But is it really a good idea?
Results released Sunday from a major study of low-dose aspirin contain a disappointing answer for older, otherwise healthy people.
"We found there was no discernible benefit of aspirin on prolonging independent, healthy life for the elderly," says Anne Murray, a geriatrician and epidemiologist at Hennepin Healthcare in Minneapolis, who helped lead the study.
The study involved more than 19,000 people ages 65 and older in the United States and Australia. The results were published in three papers in the New England Journal of Medicine.
There is still strong evidence that a daily baby aspirin can reduce the risk that many people who have already suffered a heart attack or stroke will suffer another attack.
And there is some evidence that daily low-dose aspirin may help people younger than 70 who have at least a 10 percent risk of having a heart attack avoid a heart attack or stroke, according to the latest recommendations from the U.S. Preventive Services Task Force.
But for older, healthy people, "the risks outweigh the benefits for taking low-dose aspirin," Murray says.
The primary risk is bleeding. The study confirmed that a daily baby aspirin increases the risk for serious, potentially life-threatening bleeding.
Surprisingly, those who took daily aspirin also appeared to be more likely to die overall, apparently from an increased risk of succumbing to cancer. That was especially unexpected given previous evidence that aspirin might reduce the risk for colorectal cancer.
The researchers stressed, however, that the cancer finding might have been a fluke. There's also a possibility that any colorectal cancer benefit wasn't seen because the subjects had only been followed for about five years.
Regardless, the findings raise serious questions as to whether otherwise healthy older people should routinely take low-dose aspirin.
"A lot of people read, 'Well, aspirin is good for people who have heart problems. Maybe I should take it, even if they haven't really had a heart attack,' " Murray says. But "for a long time there's been a need to establish appropriate criteria for when healthy people — elderly people — need aspirin."
That's why the researchers launched their study, called ASPREE, in 2010. It involved 19,114 older people, with 16,703 in Australia and 2,411 in the United States. The U.S. portion included white volunteers ages 70 and older, and African-Americans and Hispanics subjects ages 65 and older.
Participants took either 100 milligrams of aspirin every day or a placebo. People in the study were followed for an average of 4.7 years.
"We were hoping that an inexpensive, very accessible medication might be something that we could recommend to elderly to maintain their independence but also decrease their risk of cardiovascular disease," Murray says.
But based on the findings, Dr. Evan Hadley of the National Institute on Aging, which helped fund the study, says any elderly people taking aspirin or thinking about it should think twice.
"This gives pause and a reason for older people and their physician to think carefully about the decision whether to take low-dose aspirin regularly or not," Hadley says. "And in many cases the right answer may be: Not."
RACHEL MARTIN, HOST:
Here's a question. Can a daily baby aspirin be a kind of fountain of youth? People have been hoping so for years. A big new study has a surprising answer. NPR health correspondent Rob Stein has details.
ROB STEIN, BYLINE: Aspirin has gotten the reputation as kind of a wonder drug. Sure, it can help your headache, but aspirin can also prevent heart attacks, strokes, maybe even cancer, maybe even dementia. So a lot of people pop a baby aspirin every day.
ANNE MURRAY: A lot of people read, well, aspirin is good for people that have heart problems. Maybe I should take it. (Laughter) You know? Even if they haven't really had a heart attack.
STEIN: That's Anne Murray at Hennepin Healthcare in Minneapolis. She says about 1/3 of healthy older Americans take a baby aspirin every day. But Murray says no one knows if that's really smart.
MURRAY: For a long time, there's been a need to establish appropriate criteria for when healthy people, elderly people, need aspirin.
STEIN: So Murray and her colleagues studied more than 19,000 older people who took either a baby aspirin or a placebo every day for about five years, and the results were surprising.
MURRAY: We found there was no discernible benefit of aspirin on prolonging independent healthy life.
STEIN: People who took aspirin had no better luck avoiding dementia or other disabling medical problems, and there were risks, big time - potentially life life-threatening bleeding.
MURRAY: So the risks outweigh the benefits for taking low-dose aspirin in people who are otherwise healthy and haven't had a heart attack or a stroke.
STEIN: There was even a hint people taking aspirin were more likely to die, mostly from cancer. That was especially surprising given the evidence that aspirin might prevent colorectal cancer. While that part may have been a fluke, Murray says the findings overall are disappointing.
MURRAY: We were hoping that an inexpensive, very accessible medication might be something that we could recommend to elderly to maintain their independence but also decrease the risk of cardiovascular disease. So, yeah, it is a disappointment.
STEIN: Now, a daily baby aspirin is still totally smart for many people who have had a heart attack or stroke or are at risk for one. But Evan Hadley at the National Institute on Aging says any healthy elderly people taking aspirin or thinking about it should really think twice.
EVAN HADLEY: This gives pause and a reason for older people and their physicians to think carefully about the decision whether to take low-dose aspirin regularly or not. And in many cases, the right answer may be not.
STEIN: Rob Stein, NPR News. Transcript provided by NPR, Copyright NPR.