Warning: Low-Dose Aspirin

By Editorial Staff

For years, daily low-dose aspirin has been recommended for primary and secondary prevention of cardiovascular events, including stroke, in older adults. However, as is so often the case (pay close attention to the long list of potential side effects in the next drug ad you watch), the very thing the medication is designed to prevent may increase the risk that it occurs.

Among 19,000-plus healthy (free of cardiovascular disease at baseline older adults (average age: 74 years) enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) randomized, double-blind, placebo-controlled trial, some took a 100-mg enteric-coated aspirin daily, while others took a daily placebo (an inactive pill they thought was low-dose aspirin) for comparison. Low-dose aspirin use proved less than encouraging, to say the least, on two fronts, according to results: not only did it not significantly reduce the risk of ischemic stroke, but it also increased the risk of intracranial bleeding (which can lead to stroke).

Writing about their findings in JAMA Network Open, the study authors emphasize that "an increased tendency to bleeding may alter the balance of risks and benefits of aspirin" and that "low-dose aspirin should not be prescribed for primary prevention in healthy older adults." This adds to a recent U.S. Preventative Services Task Force guidance that notes: "The USPSTF now recommends against its use for prevention of a first heart attack or stroke in people aged 60 years or older with no clinical evidence or history of vascular disease."

Keep in mind that the study population did not involve older adults with cardiovascular disease or at high risk for CVD; in such cases, the risk-benefit profile of taking daily low-dose aspirin may warrant its use – something your medical doctor can discuss with you. In the meantime, remember that a balanced diet, regular physical activity, stress reduction and not smoking / smoking cessation all have a significant impact on heart health. After all, why take aspirin (or any other medication) if you don't have to?