Daily aspirin offers no benefits to healthy seniors, study concludes

17 Sep 2018 --- A daily dose of aspirin does not prolong healthy, independent living in older people, findings published across three papers in the New England Journal of Medicine have shown. There are proven benefits of the drug for those who have suffered heart attacks and strokes, but the study determines it offers no benefits to healthy individuals, with no cardiovascular conditions, over 70.

“Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease,” says Richard J. Hodes, M.D., National Institute of Aging (NIA) Director. 

“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,” he adds.

The initial findings are from the ASPirin in Reducing Events in the Elderly (ASPREE) trial: an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people, which was partially supported by the US National Institutes of Health (NIH).

In the total study population, treatment with 100mg of low-dose aspirin per day did not affect survival free of dementia or disability. 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. Rates of physical disability were similar, and rates of dementia were almost identical in both groups.

The group taking aspirin had an increased risk of death compared to the placebo group: 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding, state the researchers. 

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.

Regarding cardiovascular events, the researchers found that 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.

As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.

“The increase in cancer deaths in study participants in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes,” says Leslie Ford, M.D., Associate Director for Clinical Research, NCI Division of Cancer Prevention. “Analysis of all the cancer-related data from the trial is underway and until we have additional data, these findings should be interpreted with caution.”

“Continuing follow-up of the ASPREE participants is crucial, particularly since longer-term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date,” says Evan Hadley, M.D.,Director of NIA’s Division of Geriatrics and Clinical Gerontology. “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.”

As these efforts continue, Hadley emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease.

Also, the study did not address aspirin’s effects in people younger than age 65. Since only 11 percent of participants had regularly taken low-dose aspirin before entering the study, the implications of ASPREE’s findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue use.