Daily aspirin use in older adults can spark adverse outcomes

Daily aspirin use in older adults can spark adverse outcomes
Another clinical trial has added more evidence against the fairly common practice of prescribing aspirin to healthy older adults in order to prevent the onset of cardiovascular disease.

The clinical trial, which ran from 2010 to 2014 and included 19,114 individuals 70 years and older from the U.S. and Australia, found that a low daily dose of aspirin only marginally decreased a patient’s risk of cardiovascular disease while significantly increasing the patient’s risk of hemorrhage. Additionally, higher death rates were reported among those taking aspirin daily although the researchers are skeptical about how much weight to put on the finding since it’s an unexpected outcome compared to similar studies.

“For a healthy person 70 and older who doesn’t have an indication to be on aspirin, there really is no benefit to be on aspirin, in fact, the risks appear to outweigh the benefits in terms of increase bleeding risk and the potential for increased mortality risk,” said Dr. Anne Murphy, co-principal investigator of the trial and director of the Berman Center for Outcomes and Clinical Research.

The results from the trial, published Sunday in three studies in the New England Journal of Medicine, show that the rate of cardiovascular disease was 10.7 events per 1,000 person-years in the aspirin group and 11.3 events per 1,000 person-years in the placebo group. At the same time, the rate of hemorrhage was 8.6 events per 1,000 person-years in the aspirin group and 6.2 events in the control group.

Prescribing aspirin to healthy people to prevent the onset of heart disease is controversial although it happens.

There is substantial evidence that supports the daily use of aspirin for secondary prevention of heart disease, which means patients are prescribed the drug after they’ve already experienced a heart attack or stroke.

But that evidence has caused much debate over whether the drug can therefore be used to prevent heart disease before it presents itself.

The line of thinking is “well if it works to prevent a second heart attack or stroke, why wouldn’t it prevent the first one?” said Dr. John McNeil, co-principal investigator of the trial and professor in the department of epidemiology and preventive medicine at Monash University in Australia.

Other studies have been conducted that address this question with mix results. In fact, those studies prompted the U.S. Preventive Services Task Force in 2016 to change its recommendations on aspirin use for primary prevention of cardiovascular disease, limiting its use to adults 50 to 59 who have a 10% or greater risk. For adults 60 to 69, the task force recommended the decision should be made on a case-by-case basis. The 2009 task force recommendations applied aspirin use to a broader set of patients.

The latest clinical trial, which was funded in part by the National Institute on Aging, is unique because it looked at a much older population of patients compared to previous studies. The median age of the participants in the trial was 74.

Murray said she hopes the new findings will be considered by the taskforce to add to their recommendations. The U.S. Preventive Services Task Force has been unable to make a recommendation for those 70 and older because there is so little research on the population.

McNeil added it was important to focus on this cohort because aspirin is used by healthy, older people in the hopes that it will keep them well, with some even taking it without a prescription from their physician.

Taking this into account, the trial also explored the effect of aspirin on survival rates without disability. The patients who took aspirin didn’t report differences in dementia or physical disability compared to the control group.

McNeil said these findings are significant considering the size of the retirement population.

“The number of elderly people is increasing rapidly and it’s becoming important to keep people active and out of institution as long as possible not only for their own self but for the sake of the economy,” he said.

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