Are you a healthy person taking aspirin every day to prevent heart attack or stroke? It’s a long-standing rule, right?
So unless you’ve already suffered a cardiovascular incident or stroke and are taking aspirin as a secondary preventative measure under the advice of your doctor, you’ll want to reconsider.
Major study says healthy people at risk
Last year, an Australian-led study, known as the ASPREE international clinical trial, found that over an average of 4.7 years, aspirin “did not prolong life free of persistent physical disability or dementia … in 19,114 healthy community-dwelling people, most aged 70 years or older”.
It also found that aspirin “did not significantly reduce the risk of heart attacks or strokes, but the risk of serious bleeding among the aspirin takers was increased compared to the placebo group”.
The authority here comes from ASPREE being a “gold standard” trial – a randomised, double blind, placebo-controlled trial.
It was the first to investigate aspirin’s benefit versus risk in healthy older people without a history of cardiovascular disease, dementia or significant physical disability – and it put a bomb under conventional wisdom.
Clinical practice guidelines have changed: Aspirin risks outweigh benefits for healthy people
The American Heart Association and American College of Cardiology have since changed clinical practice guidelines, recommending against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.
In January, researchers from King’s College London found approximately “one in 200 people treated with aspirin would have a major bleed” – and that “taking aspirin on a regular basis to prevent heart attacks and strokes, can lead to an increase risk of almost 50 per cent in major bleeding episodes”.
In other words, for healthy people, the risks outweigh the benefits of taking aspirin on a daily basis as a preventative against cardiovascular disease.
This is a big horse that has bolted
Re-educating the public in a short amount of time will likely be difficult.
This week, a new study using data from the 2017 National Health Interview Survey (NHIS), found about a quarter of US adults aged 40 years or older without cardiovascular disease – approximately 29 million people – reported taking daily aspirin for prevention of heart disease.
Of these, some 6.6 million people did so without a physician’s recommendation.
Further, nearly half of adults 70 years and older without a history of heart disease or stroke reported taking aspirin daily.
The authors noted that a history of peptic ulcer disease – another contraindication for the routine use of aspirin – was not significantly associated with lower aspirin use as one would have expected.
“Our findings show a tremendous need for health care practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease,” said lead author Dr Colin O’Brien, a senior internal medicine resident at Beth Israel Deaconess Medical Centre and fellow at Harvard Medical School.
How big is the problem in Australia?
Professor Thomas Marwick is the director and chief executive of the Baker Heart and Diabetes Institute. He hadn’t seen any data about the use of aspirin in Australia as a primary preventative against cardiovascular disease – and it’s more likely there isn’t any.
“It’s a real problem in the US. I worked over there for 10 years and the use of aspirin in primary prevention is very prevalent,” he said.
“It never has been in Australia. I don’t know of any data to show that … it’s from my personal observation and experience. I don’t see many people who are being treated for risk factors who are on aspirin inappropriately.
“There are some. But it’s much less common here than in the US.”
Professor Marwick acknowledged though that “my sample is restricted to the people I see in my clinic”.
And the big question remains: How many people are taking aspirin daily because of online information – and without discussing the matter with their doctor? Nobody knows.
Professor Marwick was more concerned that patients with coronary artery disease, having heard news of the ASPREE study, might be confused about the findings and wrongly stop taking aspirin.
Echoes of controversial ABC report
A similar situation happened with the controversial 2013 ABC two-part report on the science show Catalyst that was critical of HMG-CoA reductase inhibitors, more widely known as statins.
The program questioned the link between high cholesterol levels and cardiovascular disease, and suggested that the benefits of statins had been overstated and the harms downplayed.
Nearly 1.5 million Australians are estimated to have viewed each part of the program.
“There were quite a number of people who had cardiac disease who stopped their statins, and some of them got into trouble … and had a recurrent event,” Professor Marwick said.
Bottom line: If you’re taking aspirin, talk to your doctor about what’s appropriate for you.