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Americans have long been told that aspirin is “the wonder drug that works wonders.” Aspirin (acetylsalicylic acid or ASA for short) was supposed to prevent heart attacks and strokes caused by blood clots. In addition, a number of studies suggested that regular aspirin intake might reduce the risk of cancers of the colon, rectum, esophagus, stomach, breast, lungs, liver, pancreas and ovaries. Sounds wonderful. But prepare for a huge flip-flop. New studies published in the New England Journal of Medicine (Sept. 16, 2018) suggest that aspirin does not prevent heart attacks in older people. Those taking ASA actually had a higher death rate from cancer. Yikes! What the heck is going on?

Why People Started Taking Aspirin to Prevent Heart Attacks:

Let’s start at the beginning. The Physicians’ Health Study was one of the most impressive clinical trials of its day. Over 22,000 male doctors were recruited. Half were randomized to take one standard dose of aspirin (325 mg) every other day. The other half received a placebo pill. This double-blind trial is the best modern medicine has to offer.

After 57 months the investigators took the highly unusual step of terminating the study early. This was not because ASA had become a problem. To the contrary, the results were too favorable. The authors shared their data over 30 years ago in the New England Journal of Medicine (January 28, 1988):

“At a special meeting on December 18, 1987, the external Data Monitoring Board of the Physicians’ Health Study took the unusual step of recommending the early termination of the randomized aspirin component of the trial, primarily because a statistically extreme beneficial effect on nonfatal and fatal myocardial infarction had been found.”

“Overall, there was a 47 percent reduction in the risk of total myocardial infarction [heart attack], which is statistically significant. This includes significant benefits of ASA on both nonfatal and fatal events.”

In 1991 a follow-up analysis of the Physicians’ Health Study reported more good news about aspirin (Annals of Internal Medicine, May 15, 1991).  Doctors who had chest pain (stable angina) had a 70% reduction in heart attacks if they were taking aspirin:

“Our data indicated that alternate-day aspirin therapy greatly reduced the risk for first myocardial infarction among patients with chronic stable angina, a group of patients at high risk for cardiovascular death.”

A More Recent ASA Analysis:

Over the last three decades there has been a great deal of controversy about the value of aspirin for preventing heart attacks and other health problems.

An analysis of ASA benefits published in PLoS One (Nov. 30, 2016) concluded that increased use of aspirin by high-risk older Americans was warranted.  Their conclusion:

“As the US works to advance the triple aim of better care, better health, and smarter spending, ensuring patients receive effective preventive care will be critical. Given aspirin’s remarkable preventive effectiveness, it is a rare example of a technology that may produce less disease and better long-term health outcomes for Americans at a low price.”

New Contradictory Aspirin Research:

Three papers published in The New England Journal of Medicine (Sept. 16, 2018) present the results of a study of aspirin to prevent heart attacks in people over 70 . The study was called ASPREE (Aspirin in Reducing Events in the Elderly).

Here is what the researchers found:

“Of the 19,114 persons who were enrolled, 9525 were assigned to receive aspirin and 9589 to receive placebo. A total of 1052 deaths occurred during a median of 4.7 years of follow-up. The risk of death from any cause was 12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group. Cancer was the major contributor to the higher mortality in the aspirin group, accounting for 1.6 excess deaths per 1000 person-years. Cancer-related death occurred in 3.1% of the participants in the aspirin group and in 2.3% of those in the placebo group.”

The conclusions:

“Higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death. In the context of previous studies, this result was unexpected and should be interpreted with caution.”

Despite the caution expressed by the authors, headlines were emphatic about the disappointing results:

“Strike Three forAspirin in Primary Prevention” in Medscape, September 17, 2018

“Daily aspirin may be harmful for healthy, older adults, large study finds” by NBC News, September 16, 2018

“Study: A Daily Baby Aspirin Has No Benefit For Healthy Older People” in Health News from NPR, September 16, 2018

The Dangers of ASA:

One of the important findings of the ASPREE trial was the increased risk of bleeding (New England Journal of Medicine, Sept. 16, 2018).

“Conclusions: The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.”

“The rate of major hemorrhage was 8.6 events per 1000 person-years in the aspirin group, as compared with 6.2 events per 1000 person-years in the placebo group.”

There were two major bleeding events: Bleeding within the upper gastrointestinal tract and bleeding within the brain.

The Bottom Line:

This ASPREE study produced no evidence that aspirin protects healthy older people (over 70) from cardiovascular complications. ASA did increase the risk for bleeding.

The People’s Pharmacy Perspective:

This was a primary prevention trial. In other words, it involved people who did not have heart disease. In that respect it was similar to The Physicians’ Health Study. The new results contradicted the earlier study. Both trials were randomized and placebo-controlled. In one, subjects took 325 mg of ASA every other day. In the ASPREE trial people over 70 took 100 mg aspirin every day.

People who already have heart disease and those who have been advised by their doctors to take aspirin should NOT stop until they have a chance to discuss aspirin use with their health care providers. There are people who are still expected to benefit from taking low-dose aspirin as a preventive measure.

We have no good answer to the question of ASA and cancer. There are a significant number of studies showing that aspirin may protect people against malignancy or reduce the risk of metastases once cancer is diagnosed. Here are some articles about this research:

How Good Is Aspirin Against Cancer in New Study?

Will Aspirin Keep Barrett’s from Turning into Cancer?

How Do You Weigh the Benefits and Risks of Aspirin?

The Bottom Line:

Healthy older people might experience more harm than benefit and should not take daily ASA on their own. People with heart disease or who are at high risk for a heart attack may benefit from aspirin. No one should embark on long-term aspirin treatment without a thoughtful conversation with a knowledgeable health professional.

Share your own thoughts about ASA in the comment section below.

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  1. Nadya
    Seattle land
    Reply

    I am 79 years old. My mom and her mom had stroke when they were 72 years old. Grandma died in one year, but mom lived till 87. I live in America for 27 years, and I took baby aspirin for 25 years (doctor’s recommendation). My two sisters in Russia (86 and 73) took baby aspirin also. I’ve never thought about heart, but was sure, that we are preventing stroke… So I was surprise they only talked about heart, not about brains. I feel well, in spite of hypertension (140/80), (my mother in law who was a very good doctor told it is not bad for older people). I’ve never had extra bleeding, walk 2 miles every day and will continue to take aspirin.

  2. Marilyn
    Fl
    Reply

    I have been taking a baby aspirin for 15 years because I have a fib
    I am also on warfarin. I am 75 now.
    I take 150 2x per day of flecanide to control a fib. This worked for awhile, but now I am in a fib all the time now.
    My pulse was so low (39) my doctor installed a pacemaker right in the heart, through the groin. I am still have no energy and am tired all the time.
    Growing old is not for sissies!

  3. JONN
    AUSTRALIA
    Reply

    This latest research is certainly confusing – it seems to me that possibly one conclusion ,from a superficial reading, is that all they proved is that the dose of baby aspirin is to small to demonstrate any positive effect and secondly – some people react very badly to aspirin, I wonder if the bleed outs from brain and gut are higher than in prior studies?

    I am 81 and have been taking 325 mg aspirin for ten years and intend to continue.
    Conflicting flurry of research reports is as disappointing as the flurry of insane politicians!

  4. B
    North Carolina
    Reply

    Quote from study write-up — “In the context of previous studies, this result was unexpected and should be interpreted with caution.” I agree, and it seems, given the headlines shown, journalists ignored this statement. And, the study did not use 85mg aspirin, prescribed by most. I won’t be taking the study results at face value.

  5. Michael
    Raleigh
    Reply

    When People’s Pharmacy first started talking about aspirin, you suggested 30mg/day. We all “settled” on 81mg because that was a quarter of a standard pill. I always suspected I should take half an 81mg/day, but they’re so small that cutting them never seemed to be worth the trouble. Maybe we should reconsider? Or take alternate days? How long does it stay in the system?

  6. Barbara G
    NM
    Reply

    There are other reasons than for the heart that I take aspirin daily. Reduces inflammation. Relieves arthritis pain and stiffness. Relieves tendonitis. Also reduces an occasional fever. Acetaminophen, et al, are not effective in these ways.

  7. Sid
    Norfolk, virginia
    Reply

    I am now 81 years old and in good health. When I was 47 I asked my doc, who was 58, if I should should start an aspirin regimen. He said that he would not recommend it but that he had been doing it for about 10 years .
    I started that day. Has it helped – not sure but I still here and have not experienced heart problems .

  8. WILLIAM
    Downey, Ca.
    Reply

    I am 88 years old & have been taking Aspirin daily for over 20 years. The last few years it has been a baby Aspirin.
    My Doctor advised Coumadin as a blood thinner.
    After reading a lot of Aspirin research I preferred to take Aspirin instead. This new research is very confusing.
    I think I will continue to take my daily Aspirin.

  9. MaryPat
    NY
    Reply

    Really confused about whether to stop and if so how to stop Quickly or pare down
    At age 84 I am concerned of excessive bleeding if surgery is needed Guess it is time for a good chat with my primary

  10. Bob
    South Carolina
    Reply

    Here is another example of using statistical numbers to arrive at an incorrect conclusion. While the 6.2/1000 and 8.6/1000 numbers suggests a large change we are still dealing with a very small probably of having an medical incident in the first place. When you look at the absolute percentage the likely hood of one having an issue when ingesting ASA is very small (0.0062% vs 0.0086%).

    As for the bleeding issue I did not see any trial data that used a daily dosage of 85 mg which is what is recommended by most doctors.

    Bottom line is that ASA’s mechanism was to thin the blood, keep clots from forming, and keep any buildup in the artery walls. Unless I missed something these are still the benefits of taking ASA and it is these attributes that results in lower cardio issues.

  11. mary
    Reply

    Both my mother and mother-in- law took aspirin and landed in the hospital , my mother-in-law lost 3 pints of blood my mom lost 6 pints of blood due to aspirin. Many friends of mine are taking baby aspirin and all are going blind.

    • Bev
      CA
      Reply

      Do you know the dosage amount for both family & friends? Why were family members hemorrhaging?

  12. Dave
    Wisconsin Rapids, WI
    Reply

    I am 82. I was prescribed a daily aspirin several years ago and accepted the recommendation without question. I have no history of heart problems and there is none in my family (I am one of 8 children aged 70 to 90, all living. My patents lived to 90 and 95 and died at home in their bed). I do take medication to control my blood pressure (successfully so far). My experience since taking the daily aspirin regimen is excessive bleeding for even minor nicks and cuts which I find to be a real nuisance. On the basis of recent news reports I have quit my daily aspirin and will notify my primary care doctor of my decision.

  13. Jerry B
    Conroe, TX
    Reply

    The question to answer is, “who funded the study?” If it was big pharm, it is worthless.

    • Terry Graedon
      Reply

      Bayer provided aspirin and placebo for the study. With so many people, that’s a lot of pills! Other funding was from governmental agencies, both Australian and US, and independent institutions (Monash University and the Berman Center for Outcomes and Clinical Research). The sponsor was the Minneapolis Medical Research Foundation.

  14. macfish
    MS
    Reply

    My retinologist recommended low-dose aspirin because blood was flowing too slowly in me eyes. I guess I will need to discuss this with my primary-care doc now. I wonder if my test results mean that I will benefit from aspirin.

  15. laura b
    ga
    Reply

    This is timely for me. I’m 68 yr old female, healthy except for slightly elevated blood sugar; I am on 500 mg metformin daily. My Doc told me to go ahead & start baby aspirin per day. THe last two days, I have had scary nosebleeds; pinched the nostril for 1/2 hour to stop it, but swallowed and mopped up lots of blood in the meantime. I attribute this to my blood being TOO thin to coagulate quickly. I will back away from the baby aspirin gradually.

  16. Terry
    San Mateo, Ca
    Reply

    The only thing I can say is, I have taken 2 extra strength aspirin every day for arthritis, for 35 years. I have never had cancer, or heart problems. My father, mother, sister all have had cancer and they did not take aspirin.

  17. H.B.
    Reply

    There are many studies that contradict each other. It appears the less meds you can take the better your health will be.

  18. Anina
    Denmark
    Reply

    I’m sorry, but since aspirin reduces (big time) the sales of several drugs for the prevention of post-treatment of cardiovascular and heart diseases, including statins, in addition to my knowledge of medical statistics which follows their own rules, differing from other statistical sciences – I see no reason to trust the results of those recent studies. No reason whatsoever.

    I’m born in 1950 and had been following medical research since it was still credible.

    Thank You.

    • Bev
      Ca
      Reply

      I agree. Most times drug companies pay for these results to be always in their favor so we only take there’s. But guarantee that if you ask them (CEO’s) making the drugs what are they and family are taking … in this case, you can bet they are taking aspirin and not the drugs they are manufacturing. That goes for genetics as well. When we must take drugs for life saving or quality of life, the Drs etc all use Brand and not generics.

  19. Anina
    Denmark
    Reply

    I’m sorry, but since aspirin big time reduces the sales of several drugs for the prevention or post-treatment of cariovascular and heart diseases, including statins, in addition to my knowledge of medical statistics, which follow its own rules, differing from other statistical sciences – I see no reason to trust the results of these recent studies. None reason whatsoever.

    I’m born in 1950 and had been following medical research since it was still credible.
    Thank You.

  20. Carla
    NE Ohio
    Reply

    There has been substantial research showing that aspirin in effective in preventing breast, lung, colon, and many other cancers, and aspirin has even been successfully used to treat lung cancer in smokers. My cousin who had breast cancer is on a cancer regimen to prevent recurrence. How does this jibe with the latest studies showing greater incidence of cancer among daily aspirin users? We really need answers on this!

    • Sandy
      Seattle WA
      Reply

      Good point but since Bayer was one of the sponsors—why would they want these results
      (showing healthy adults don’t need aspirin)? I, too, am suspicious of funders.

  21. George M
    West Virginia
    Reply

    I am slightly over 70 and in reasonable good health but 20 pounds above my desired weight so call me chubby. I have taken Aspirin when I had experienced unknown chest pressure and more than once had a slight radiating pain coming from left shoulder and traveling across my chest . I decided to take a extra strength aspirin with glass of warm water to speed up aspirin’s effect and I went and relaxed by laying down . The action I took has each time resulted in my condition disappearing.

    I live about 45 minutes away from an ambulance best response time so this seems personally the best option. My annual physical check up continues to indicate only a heart murmur which was first detected at last physical leaving military service.

    I want to make the point here that chewing aspirin can result in tissue damage in the oral area so the warm water might be a better alternative in speeding the benefits of aspirin to the blood stream. The laying prone also reduces physical stress and evens out gravity upon the circulatory system with change of angle.

  22. Jos
    Rhode Island
    Reply

    Here we go again. Has there been a piece of medical research in the past twenty years that doesn’t take a completely opposite position years later e.g. salt, statins, etc.

  23. Gerry
    Fla
    Reply

    Aspirin was a major cause of my angioedema as I took too much (3 a night) for several years, causing tongue and facial swelling which almost killed me. I now steer clear of all salicylates and carry benedryl with me at all times in case of accidental ingestion in some food from outside sources (buffets, etc) to avoid repetition of this life threatening effect.

    • Jeannette
      Scotland
      Reply

      Agree H.B if you can keep healthy with good food and exercise (and I think a relaxed disposition) absolutely the best thing.

      What I did followed an awful lot of research on my own personal symptoms and I advocate that everyone do this. If you have an open minded GP (and not all of them are) you should discuss it with him.

      Sorry this is a bit long but hopefully helpful story spans about 10 months last year (bear with me I do get back to the link I think exists with aspirin):
      Interesting Gerry about 6 months after starting both Ticagrelor and baby aspirin after a minor heart attack I got what the doc (and me) though was shingles. this appeared to be cleared with antiviral meds but i went on to suffer a series of skin rashes facial (diagnosis uncertain) hand and arm rash diagnosed as eczema, initially given Flucloxacillin which seemed to help but starting a second course made matters worse. Deemed to have a reaction against the antibiotic and stopped the course.

      About 6 months into using aspirin and ticagrelor I was still getting some breathlessness (a known side effect from ticagrelor along with easy bruising) – but I took both meds for the recommended 6 months. When I stopped the Ticagrelor the bruising stopped and the breathlessness reduced but was still there. (The aspirin 75mg was to be a lifelong med). The rashes continued. So I started reducing the use of aspirin – and treated my skin with natural (mostly organic) methods: APC (internal and external), coconut oil, oats (internal and external) and very dilute household bleach (a recognised eczema treatment). I had occasional flares but general trend for improvement continued to be positive and I am now clear bar my scalp which is non-the-less hugely improved (I lost about a third of hair thickness during this period too- this is now growing back – employing a different natural treatment regime having research and dismissed orthodox treatments).

      I have improved my diet and keep very active and now feel very good –
      no breathlessness. I have more or less stopped the aspirin now – and use it if I am feeling a bit off – which has happened on just a few occasions- and I feel better very quickly.

      I certainly know that aspirin is critical at the onset of a heart attack – a life saver. But I have a strong belief that lifelong aspirin after my minor heart attack was certainly not right for me as I believe I am likely sensitive to the salicylic acid in aspirin if used on a daily basis.
      Search ‘skin’ and ‘adverse reactions’ at the link below. However using aspirin the way I do (for me) shows the problem of the one size fits all approach is not good – this is now being recognised and we are seeing more of the term ‘Personalised Medicine.’ At 5ft 2” my meds mg was the same dose as for a 6ft man who weighs twice my weight. Just cannot be right. So even a low dose aspirin may be excellent for some and deadly for others. Everyone is biologically unique and we all need to learn who we are physiologically as well as emotionally.
      https://en.wikipedia.org/wiki/Aspirin#Skin

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