A nationwide survey of people aged 45 to 75 found almost half the respondents were taking aspirin to ward off heart problems, even though they had no history of cardiovascular disease.
Vast numbers of doctors still urge this strategy on their patients. And after all, who wouldn’t want to lower their risk of the nation’s biggest killer with a cheap, low-dose remedy, free of any noticeable side effects?
But other doctors say this is a bad idea. They argue the benefits — if any — are outweighed by the risks, which include a higher risk of death.
This debate among medical professionals has been going on for years, but now a major new trial may finally put an end to this argument once and for all. . .
When eminent physicians line up on opposite sides, it leaves lay people puzzled and confused. Who should they listen to?
Peter Elwood, Honorary Professor of Medicine at Cardiff University, Wales, describes aspirin as a “miracle drug” that will slash heart attack risk by 30% and save lives. True, there’s an increased risk of hemorrhage, but he argues that this bleeding isn’t fatal.
Meanwhile Peter Sever, Professor of Clinical Pharmacology at Imperial College London, maintains any benefit for those who have no history of heart disease is tiny, and is offset by a much bigger risk of severe, potentially life-threatening bleeds in the digestive tract and the brain.
Researchers from the US and Australia hoped to nail down the final answer to this debate with a trial of 19,114 men and women over the age of 65. All were free of heart disease, dementia or physical disability at the start of the study.
Half took 100 mg of aspirin daily while the other half swallowed a placebo. The trial lasted 4¾ years. The researchers just published their findings as three separate papers in the New England Journal of Medicine.
No Benefit for Healthy Older People
First, they looked at disability-free survival – a composite of death, dementia and chronic physical disability. The purpose was to see whether taking aspirin led to enjoying longer health, fitness, independence and lifespan.
The answer was no, it had no effect. However, there was a 38 percent increased rate of major hemorrhage in the aspirin group.
Next they looked at the rate of cardiovascular disease. Here again they found aspirin did not significantly lower the risk.
The final outcome measure was all-cause mortality – i.e. how many deaths occurred regardless of cause. During the follow up there were 1,052 deaths. The risk of death was 14 percent higher in the aspirin group.
The main reason for this outcome was a 31 percent increase in death from cancer. This came as a surprise because other studies show aspirin reduces the risk. The authors said this finding should be “interpreted with caution.”
The lead author, Professor John McNeil from Monash University, Melbourne, Australia, said, “It means millions of healthy older people…who are taking low dose aspirin without a medical reason, may be doing so unnecessarily because the study showed no overall benefit to offset the bleeding.”
Medics Agree: “Don’t Do It”
Many experts were asked to comment on the study:
In the opinion of Stephen Evans, Professor of Pharmacoepidemiology at the London School of Hygiene and Tropical Medicine, ” …benefits of aspirin in healthy people are at best limited, and [it] may well be harmful, and this harm may be increased beyond age 73.”
Jane Armitage, MD, Professor of Clinical Trials and Epidemiology at the University of Oxford, remarked, “In parts of the world — in the US and also I think in Australia — there’s quite high usage of aspirin in [preventing heart disease]. I think people need to think very hard about whether or not that’s a good thing.”
And Dr. Kausik Ray, consultant cardiologist at Imperial College London, took a hard line: “…aspirin does not have a place in the routine use for primary prevention…”
John Cleland, also from Imperial added, “It’s certainly a very interesting result — a significant increase in cancer, a significant increase in all-cause mortality, a significant increase in bleeding, so it looks like the recommendation for aspirin is: don’t do it.”
Vincent Bufalino, MD, Medical Director of the Advocate Heart Institute, Naperville, Illinois, threw in his pennyworth: “I, in my personal practice, have been stopping my seniors who are all taking aspirin because, good-naturedly, they all assume that it’s helping prolong their life or improve their life.
“[This study] reinforces for us that people who do not have heart disease do not need aspirin.”
My take: I’ve opposed the aspirin-a-day nonsense for decades. The reasons are obvious and have been known all along: It can lead to bleeding of brain and GI tract. The purpose of the aspirin is to reduce inflammation and thin the blood (to avoid clotting that can cause heart attacks and strokes.)
But there are countless natural anti-inflammatories and blood thinners that do not carry any risks and are good for you. Proteolytic enzymes like bromelain come to mind.