Doctors have suggested one low-dose aspirin a day to help avoid heart attacks and strokes, but a recent study suggests healthy, older people who don’t currently take it shouldn’t start.
The study followed about 20,000 people in Australia and the United States. Most of them were over age 70 — part of the age group at higher risk for heart attacks and strokes. They took 100 milligrams of low-dose aspirin — or a placebo — every day for a median of 4.7 years.
Not only did the aspirin faile to lower their risk of cardiovascular disease, it also increased their rate of bleeding and a higher rate of death.
“In my particular practice, if someone has been on low-dose aspirin for many years and they haven’t had any issues with bleeding or other issue, I probably will not stop it,” said Dr. Neeraj Badhey, a cardiologist with Texas Health Hurst-Euless-Bedford. “But I may not start people on it going forward.”
The study results don’t apply to people who’ve had a heart attack.
"The data is very clear,” Badhey said. “If you’ve had a heart attack or stroke in the past, aspirin is very important to prevent recurrence.”
About the study: It was called the ASPREE trial. It studied about 20,000 people in Australia and the United States. Most of them were over age 70 because that’s a higher risk population, theoretically. As you get older, that’s the age (65 to 70) where the risks start increasing.
Results: What was shocking about the study was aspirin did not benefit any of these people for primary prevention; none of these people had a heart attack or stroke in the past. There was actually a higher bleeding rate and a higher risk of death if you did take aspirin.
Why put an healthy, older person on low-dose aspirin to begin with: There are people who are higher risk for having a stroke or heart attack event. And when you try primary prevention, the data were always mixed. So you always try to target the riskier patients.
Those on low-dose aspirin should not stop. Talk to your doctor: That’s the gray area. I think most of us, based on the data, would say if someone’s not on aspirin and they’re healthy and no prior cardiovascular issues, you probably wouldn’t start them on aspirin.
What to do with patients already on aspirin: They’ve already selected themselves to tolerate it. They haven’t had any bleeding issues. And that’s sort of an individual, case-by-case basis. In my particular practice, if someone has been on low-dose aspirin for many years and they haven’t had any issues with bleeding or other issue, I probably will not stop it. But I may not start people on it going forward.
Study doesn’t apply to people who’ve had a heart attack or stroke: The data are very clear. If you’ve had a heart attack or stroke in the past, aspirin is very important to prevent recurrence.
To avoid possibility of having to take aspirin, risk factor modification:
- If you’re a diabetic, control your diabetes.
- If you’re a smoker, quit smoking.
- Control your cholesterol.
Also: The actual incidence of cardiovascular events was lower than predicted. It shows we as a society have gone a long way in actually reducing rates of heart attacks and strokes by risk factor modifications. There’s a theory that maybe aspirin didn’t prove to be as beneficial in a study because we’ve already done a very good job at controlling the risk factors.
Interview responses have been lightly edited for clarity.