An Aspirin a Day of No Benefit for Fit and Healthy Elderly

Every morning, millions of elderly people without a medical reason take a low dose of aspirin. They have been doing this in the hope of preventing, among other things, a first heart attack or stroke, despite the evidence supporting this to be sparse.
Although this lack of evidence has been noted in clinical guidelines, the practice has persisted for decades.
Now, a major Monash University-led study has shown that daily low-dose aspirin (100mg), when initiated in otherwise healthy people from age 70 onwards, has no benefit in prolonging life free of disability, or substantially reducing the risk of having a first heart attack or stroke.
The study, which began in 2010, was led in Australia by Monash’s Professor John McNeil and Associate Professor Robyn Woods, from the School of Public Health and Preventive Medicine based at the Alfred Medical Research Precinct.
It was a joint US and Australian study comparing low-dose aspirin and placebo in otherwise healthy elderly people aged 70 or more.
The US component of the study was led by Professor Anne Murray and Brenda Kirpach from the Berman Center for Outcomes and Clinical Research in Minneapolis.
These new findings are now mapped out in three papers in the New England Journal of Medicine.
More than 19,000 people in Australia and the US – 16,700 of them in southeastern Australia – were studied over seven years. The study was called ASPREE – Aspirin in Reducing Events in the Elderly.
The results showed that low-dose aspirin did not prolong healthy life. Nor did it prolong life or substantially reduce the incidence of heart attack or stroke – with little difference between the placebo and aspirin groups.
“The take-home message of such a complex, large, placebo-controlled study is that healthy older people contemplating how best to preserve their health will be unlikely to benefit from aspirin,” said Professor McNeil, the head of Monash University’s Department of Epidemiology and Preventive Medicine.
But bleeding, a well-known side-effect of aspirin, was borne out by the study, with a small increase (3.8 per cent) in cases of serious bleeding among aspirin takers versus (2.8 per cent) in those who took placebo.
“It means millions of healthy older people around the world who are taking low-dose aspirin without a medical reason may be doing so unnecessarily, because the study showed no overall benefit to offset the risk of bleeding,” Professor McNeil said.
He said that while aspirin remained a relatively safe medication, it was not benign and patients should follow the advice of their doctor about daily low-dose use.
He cautioned that ASPREE’s results do not apply to those with existing conditions such as a previous heart attack, angina or stroke, where aspirin is recommended as a valuable preventive drug.
The ASPREE results published today provide a long-overdue answer to an important medical question: whether aspirin has a beneficial effect for our healthy older citizens.
Monash University Vice-Chancellor, Professor Margaret Gardner, AO, said the groundbreaking research put the University at the forefront of international innovation and consolidated it as a leading research institute.
“Monash is committed to the translation of research that addresses global health priorities,” Professor Gardner said. “ASPREE really is the gold standard of clinical trials, and its findings will influence healthcare guidelines around the world for generations to come.”