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Daily aspirin may involve more risk than reward

17 September 2018

The results of the study, led by Mr John McNeil of Monash University in Melbourne, were released in three articles in the New England Journal of Medicine.

When the participants were followed up almost five years later, doctors found that compared with the placebo, a daily aspirin had not reduced the risk of heart attack or stroke, or prolonged the number of years people lived without dementia or physical disabilities.

Significant bleeding - a known risk of regular aspirin use - was also measured.

Doctors unexpectedly also found that the group taking aspirin died at a slightly higher rate than the placebo group, with most of those deaths attributed to cancer.

In the UK, GPs generally do not advise aspirin for pensioners who have not previously suffered cardiovascular problems, such as a heart attack or stroke.

McNeil added that a small increase in deaths observed in the aspirin group, primarily from cancer, required further investigation as researchers can not rule out that it may be a chance finding.

Dr Richard Hodes, director of the National Institute on Ageing said: "Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease".

The participants were then followed for an average of 4.7 years. Additionally, higher death rates were reported among those taking aspirin daily although the researchers are skeptical about how much weight to put on the finding since it's an unexpected outcome compared to similar studies.

Two other studies aimed to identify the effects aspirin can have on the body.

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Participants had to be 70 years or older (or 65 and older among blacks and Hispanics in the U.S.). "It is possible pre-existing cancers may have interacted with the aspirin".

The small increase in deaths, mostly from cancer, may be coincidental and needs more study, the authors said.

"But we have not identified results that are strikingly different", McNeil said in an email. The patients who took aspirin didn't report differences in dementia or physical disability compared to the control group.

Cardiologist Dr. Erin Michos called the results, "alarming", saying that aspirin should be prescribed only selectively.

If you're taking a daily aspirin to stay healthy, new evidence suggests you might want to reconsider. Patients now get statins to lower cholesterol and anti-hypertensive medications to lower blood pressure. Half of those people used daily aspirin and the others did not.

Peter Rothwell, professor of neurology at the Centre for the Prevention of Stroke and Dementia at the University of Oxford, said taking the tablets if healthy, over the age of 70 and have not had a previous heart attack or stroke, is "really of very little benefit".

Aspirin is not recommended for people who are pregnant or breastfeeding, have an active or previous stomach ulcer, or have a medical condition associated with bleeding.

That's a decision Dr. Mark Huffman plans to make in conversations with his patients.

Daily aspirin may involve more risk than reward