Low-dose aspirin doesn't extend healthy living in older people

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Contrary to popular belief, an aspirin-a-day may not quite work as a preventive in older people who have not had a heart attack.

It may ultimately turn out that there are more benefits than risks in certain populations, said the study's lead author, John McNeil, a professor in the department of epidemiology and preventive medicine in the School of Public Health and Preventive Medicine at Monash University in Melbourne.

Though aspirin has been around for more than 100 years, it was unclear whether healthy older people should take it as a preventive to keep them healthy for longer, he says, adding "aspirin is the most widely used of all preventive drugs and an answer to this question is long overdue".

Researchers also found the use of low-dose aspirin did not substantially lower the risk of cardiovascular disease in healthy older adults, and instead significantly increased their risk of major haemorrhage (bleeding that can lead to a stroke). However, the higher death rate was due to more cancer deaths in the aspirin group, which could have been due to chance, the researchers said.

Participants took either aspirin or a placebo daily over a four-and-a-half year period.

"This gives pause and a reason for older people and their physician to think carefully about the decision whether to take low-dose aspirin regularly or not", Hadley says. One cardiologist not involved with the study notes that in the time since the original research on aspirin was done, patients can now take other medications to lower cholesterol and blood pressure, and suggests it's time to "phase out" the broad use of preventative daily aspirin.

When the researchers looked at death, disability and dementia, they found virtually no difference between the aspirin-taking group and the group given a placebo: 21.5 events per 1000 person-years in the former and 21.2 per 1000 person-years in the latter.

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Scientists looked at almost 20,000 healthy Australians and Americans aged over 70, and found taking low doses of aspirin for five years had no benefits - and it actually caused some harm. A big new study has a surprising answer.

However, all of the experts agreed that if you're now taking aspirin under a doctor's direction you shouldn't stop until you discuss it with them, regardless of your age. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.

"Many people are taking aspirin for important medical reasons", McNeil said.

"There's definitely an increased bleeding risk, and it's not benign", said Dr. Vincent Bufalino, a cardiologist and spokesman for the American Heart Association. They were followed for an average of close to five years.

Dr Nespolon said while there have been mixed opinions on whether giving healthy people aspirin is a good idea, this new study "clearly shows people over 70 shouldn't be taking aspirin as simply an aid to their health".

No individual component of the primary endpoint made a case for the benefit of aspirin, which failed to reduce the risk of cardiovascular disease as well (10.7 versus 11.3 events per 1,000 person-years, HR 0.95, 95% CI 0.83-1.08).

Millions of people take small doses of aspirin, like a baby aspirin, every day to reduce their risk of having a heart attack or stroke. Further research that may identify which groups would benefit from regular aspirin use is underway, McNeil said.

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