BABY ASPIRIN—TAKE IT OR TOSS IT?
In my post Lessons of Getting Older last month I wrote of taking a fall during the Ventura half marathon and “bleeding buckets” for the last 3 miles, I didn’t mention that as soon as I crossed the finish line I was whisked into the first aid tent. The first thing they asked was if I was taking a blood thinner. I answered, “Just baby aspirin.”
“That explains all the bleeding,” was the reply I got from the nurse. I had been taking it for only a few months. My doctor knows I try to avoid supplements, but she advised me last spring to begin the standard daily low-dose (81-mg) of “baby” aspirin. I’ll ask her again on my next visit and this time she might have a different answer.
In September, the New England Journal of Medicine published the results of three studies and concluded that a daily low-dose aspirin regimen provides no significant health benefits for healthy older adults. And, it actually may cause them serious harm.
Here are excerpts from the November 2018 Harvard University article Rethinking low-dose aspirin:
“Aspirin remains a cornerstone of treatment after a heart attack or stroke. But the question of whether people with a low to moderate risk of heart disease should take aspirin is a really important one,” says Dr. Christopher Cannon, a cardiologist at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School. Tens of millions of people in the United States fall into that low-to-moderate-risk category. But until now, there weren’t many large trials that included those people, he notes.
Aspirin: Pros and cons
Aspirin helps thwart dangerous blood clots that can lead to a heart attack or stroke. But there’s a price to pay for that protection: a higher risk of bleeding. It also irritates the stomach lining, so gastrointestinal bleeding is a key concern for people who take it regularly.
For people with known heart disease — those who’ve already experienced a heart attack or certain forms of stroke — a daily low-dose (81-mg) can help prevent a repeat of these serious events. This so-called secondary prevention is widely recommended. The benefit of avoiding a heart attack or stroke offsets the risk of serious bleeding by about six to one. But taking aspirin to prevent a first heart attack or stroke (primary prevention) is more controversial.
For people with risk factors
One of the new studies included more than 15,000 people with diabetes, a disease that boosts the risk of cardiovascular problems by two to three times. The study volunteers took a 100-mg aspirin tablet or a placebo for an average of nearly seven-and-a-half years.
Over all, the benefits of aspirin were partially counterbalanced by the risks. For every 1,000 people taking it, 11 avoided a serious vascular event (heart attack, stroke, ministroke, or cardiovascular-related death). But nine experienced bleeding that was serious enough to result in hospitalization or death, which means the risks and benefits were about the same.
The second study included more than 12,500 people, all of whom had several risk factors for heart disease, such as elevated cholesterol, high blood pressure, or being a smoker (but not diabetes). They also took a daily 100-mg tablet or a placebo. Over a five-year period, aspirin did not lower heart attacks or related events. Gastrointestinal bleeding was low, but it was twice as likely to occur in people who took aspirin.
Older people, greater risk?
The third study focused on older people: whites ages 70 and older and blacks and Hispanics (whose baseline risk is slightly higher than that of whites) ages 65 and older. The 19,000-plus participants took 100 mg of aspirin or placebo daily for a median of 4.7 years.
Aspirin did not lower the risk of cardiovascular disease, dementia, or disability. But it did raise the risk of bleeding severe enough to require transfusions or hospitalization.
The take-home message
“Often, people come into my office and tell me they’re taking aspirin because they’ve heard it prevents heart attacks,” says Dr. Cannon. These new studies show that’s not always the case — and that it may do more harm than good for people who’ve never experienced a heart-related event.
In a nutshell, people with diabetes appear to benefit from aspirin, but the risk of bleeding offsets some of that benefit. These studies suggest that for people who don’t have diabetes — as well as anyone who is age 70 or older — aspirin provides no heart benefit and seems to increase your odds of bleeding. This means some people currently taking the low-dose tablets should consider stopping it, says Dr. Cannon. (Note that these findings don’t change the advice for people who’ve already had a heart attack or stroke; for them, aspirin is still recommended.)
My take on this is that if you’re a healthy older adult, it might be time to toss out the baby aspirin.
Still, the decision to take low-dose aspirin is complicated; you should always talk to your doctor before stopping or starting any medication.
Happy Thanksgiving!