Why daily aspirin therapy for heart disease might not be safe for everyone
December 20, 2018
Since the 1970s, taking a daily low-dose aspirin has been considered a safe, effective therapy to lower the risk of heart attack, stroke, and heart disease. The American Heart Association routinely recommends aspirin to people at risk for heart attack, as well as heart attack survivors.
However, just as eating an apple every day won’t magically “keep the doctor away,” taking daily low-dose aspirin won’t prevent all heart disease and might do more harm than good for some patients – even those who have been on aspirin therapy for years.
The Aspirin in Reducing Events in the Elderly (ASPREE) trial sought to weigh the known aspirin therapy risk of bleeding in the gastrointestinal system or brain with overall cardiovascular benefits. The trial involved monitoring people in Australia and the U.S. who were at least 65 (most were at least 70) and in relatively good health with no heart disease at the beginning of the study.
The results of ASPREE, which were published in three articles in The New England Journal of Medicine in Sept. 2018, suggest that aspirin use:
● Didn’t result in lowered risk for heart disease in healthy older adults
● Led to higher death rates, primarily due to cancer
Additionally, ASCEND – a separate study published in Aug. 2018 – found that increased bleeding risks largely overshadowed the cardiovascular benefits of daily aspirin use in patients 40 and older with diabetes, which is a well-known risk factor for heart disease.
“Just as eating an apple every day won’t magically ‘keep the doctor away,’ taking daily low-dose aspirin won’t prevent all heart disease and might do more harm than good for some patients – even those who have been on aspirin therapy for years.”
How are these data different from past research?
The first studies that looked at the association between taking aspirin and a reduced risk for heart disease first appeared in the 1970s, though some doctors recommended aspirin therapy back in the 1950s and ’60s. However, a lot has changed since then.
Many more people smoked in the ‘70s, which undoubtedly influenced the results. In addition, aspirin studies in the 1980s looked at a variety of populations (usually men) and then extrapolated the results of these studies to all individuals.
But without evaluating how aspirin affected female participants, researchers were getting only half the story. It wasn’t until the Women’s Health Initiative started looking specifically at female participants that we had data that showed aspirin might not prevent heart disease in people who weren’t already at high risk. ASPREE and ASCEND involved both male and female patients.
Also, the unique needs of older adults were not examined in the former recommendations. Researchers tended to assume that if aspirin could benefit a 60-year-old it logically would benefit a 70-year-old. However, the ASPREE trial observed the effects of aspirin on older participants, further reinforcing the necessity of conducting more research before applying conclusions to a large population.
Related reading: It’s time to rethink taking daily, low-dose aspirin
If I take aspirin for heart disease, should I stop?
Not necessarily. Patients should check in with their doctors to see whether the risk of brain or gut bleeding during aspirin therapy outweighs their heart-health benefits. Long-term bleeding can cause complications such as anemia or even hemorrhagic stroke in certain patients. In patients with known cardiac and vascular disease, the benefits of aspirin exceed the bleeding risk.
We used to consider taking low-dose aspirin as a sort of healthy aging milestone. But the ASPREE and ASCEND data suggest that we should examine the benefits and risks of aspirin therapy for each patient rather than making broad generalizations. Whether you currently take aspirin every day or you’re considering it, talk to your doctor about the implications of this study on your health and whether aspirin therapy is right for you.