Research led by Monash University has reaffirmed findings from 2018, revealing that daily low-dose aspirin does not provide long-term cardiovascular benefits for healthy older adults. Instead, it increases the risk of major hemorrhage. This conclusion emerged from a study published in the European Heart Journal, involving 15,668 participants from Australia and the United States, primarily aged 70 and above.
The study participants, who had no history of cardiovascular disease, dementia, or significant physical disability, were initially part of the ASPREE clinical trial. They were followed for more than four years post-trial in the ASPREE-eXTension study. The original ASPREE trial, conducted from 2010 to 2014, involved random allocation of participants to receive either 100mg of aspirin daily or a placebo, with a median follow-up of 4.7 years. The extension study added another 4.3 years of observation, culminating in a combined median follow-up period of 8.3 years.
Key Findings and Expert Insights
Professor Rory Wolfe, a principal investigator of the ASPREE-XT study, highlighted the study’s implications. “During the combined follow-up period, there was no evidence of cardiovascular prevention with aspirin, but there was a significant increase in major hemorrhage risk for those on aspirin compared to those on placebo,” he stated.
“Surprisingly, during the post-trial phase, participants initially randomized to aspirin experienced a 17 percent increase in major adverse cardiovascular events compared to those on placebo,” Professor Wolfe noted.
These findings suggest that the long-term use of aspirin may not only fail to protect against cardiovascular events in healthy older adults but also significantly increase the risk of hazardous bleeding complications. The study advises individuals taking aspirin for primary prevention to consult with their doctors about possibly discontinuing the drug, although this does not apply to those using it to prevent recurrent cardiovascular events after an initial occurrence.
Historical Context and Broader Implications
The ASPREE trial, known as ASPirin in Reducing Events in the Elderly, initially aimed to explore aspirin’s potential benefits in preventing cardiovascular events among older adults. The trial involved over 19,000 participants across Australia and the US and continues today as a longitudinal study.
Historically, aspirin has been widely used for its blood-thinning properties, believed to reduce the risk of heart attacks and strokes. However, recent studies, including ASPREE, have challenged this long-standing assumption, particularly for primary prevention in older adults without prior cardiovascular events.
Expert Opinions and Future Directions
Dr. Andrew Tonkin, a co-author from the School of Public Health and Preventive Medicine, emphasized that while some individuals might benefit from aspirin for primary cardiovascular prevention, the risks and benefits should be carefully weighed in consultation with a healthcare provider.
“Certain individuals might still benefit from aspirin for primary cardiovascular prevention, but they should carefully consider the risks and benefits in consultation with their GP,” Dr. Tonkin advised.
The implications of these findings are significant, prompting healthcare providers to reconsider aspirin’s role in preventive medicine for older adults. As the medical community continues to evaluate the risks and benefits of aspirin, personalized medical advice becomes increasingly crucial.
Looking Ahead
The ASPREE project, funded by the National Institutes of Health (USA) and the NHMRC (Australia), is led by Monash University in Australia and the Berman Center for Outcomes & Clinical Research in the US. It remains a pivotal study in understanding aspirin’s effects on older populations.
As research continues, the medical community anticipates further insights into aspirin’s role in preventive care. Patients currently taking aspirin for primary prevention should engage in informed discussions with their healthcare providers to determine the best course of action based on the latest evidence.
For more information and to access the full study, visit the ASPREE website at ASPREE.
