Daily Aspirin Increases Risk Of Bleeding, Death In Older Persons With Few Heart Benefits: Studies

New research raises questions about the common practice of recommending older individual take an aspirin per day, suggesting that it may carry more risks than benefits. 

For decades, doctors and health experts have advised older patients to take a daily aspirin to prevent heart disease and other health issues, including cancer. However, a group of researchers, known as the ASPREE Investigator Group, are now questioning that wisdom.

The group published three studies this month in the New England Journal of Medicine. One study looked at how daily aspirin affected cardiovascular events and bleeding in healthy elderly patients. Another study looked at the effects of aspirin on all-cause mortality on health elderly patients. The third study looked at aspirin’s side effects on disability-free survival in the healthy elderly.

“Current guidelines in the United States, Europe, and Australia have noted that there is limited evidence regarding the use of aspirin for primary prevention of cardiovascular disease in the elderly,” the researchers noted. “Nevertheless, many millions of relatively healthy older persons in the United States and Australia take low-dose aspirin with the assumption that it will reduce the likelihood of future cardiovascular disease and stroke.”

Overall, the studies indicate that taking daily aspirin may increase the risk of major bleeding events and death, fail to prevent heart disease any better than a placebo, and do not prolong disability-free survival. The report indicates that authors were particularly disturbed to find an increased rate of cancer deaths among elderly patients who took a daily dose of aspirin.

The researchers noted that several large studies have verified the effects aspirin has for preventing heart disease among patients with a history of heart disease or stroke. However, these studies look at the effects on elderly patients who were healthy when they began taking an aspirin per day.

The three studies were all the result of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, which involved a randomized, placebo-controlled trial of the daily use of 100mg dose of aspirin. The trial ran from 2010 through 2014 in the U.S. and Australia, involving nearly 20,000 people with a median age of 74.

Among the results, the risk of death from any cause was 12.7 events per 1,000 person-years among those who took aspirin, compared to only 11.1 events per 1,000 person-years in the placebo group. Cancer accounted for 1.6 excess deaths per 1,000 person-years in the aspirin group, contributing to 3.1% of deaths in that group. Cancer only contributed to 2.3% of deaths in the placebo group.

“Higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death,” the researchers concluded. “In the context of previous studies, this result was unexpected and should be interpreted with caution.”

Other results included an increased rate of major hemorrhaging among aspirin users, a failure to significantly lower the risk of heart disease, and a failure to increase the disability-free survival rate of healthy elderly patients.