Why aspirin may not keep the first heart attack away in older people

Contrary to popular belief, an aspirin-a-day may not quite work as a preventive in older people who have not had a heart attack.

These were the findings of a seven-year study into the benefits and risks of a daily, low dose of aspirin in people over 70 years. “An aspirin-a-day did not prolong life free of disability, or significantly reduce the risk of a first heart attack or stroke among participants with little difference between the placebo and aspirin groups,” according to the study, led by a team of researchers from Monash University, Melbourne. Three papers, based on the study, have just been published in the New England Journal of Medicine .

“It has been known long enough that there was no clear reason to advice one way or another on taking an aspirin a day in older people,” John McNeil, principal investigator and head of Monash University’s Department of Epidemiology and Preventive Medicine, told BusinessLine . And while it “does not do any good” in the defined group of people, he says, “it may increase the risk of bleeding” (bleeding is a known side effect of aspirin and is more common in older people).

The study was done on Caucasians, but its findings may not be too different in an Indian population, said McNeil, responding to a query. “There is no evidence that people from Asia (or India) reacted any differently to aspirin,” he said. Once published, McNeil expects regulatory authorities to take note of the latest findings . The trial will result in a rethinking of global guidelines relating to the use of aspirin to prevent common conditions associated with ageing, he says.

Though aspirin has been around for more than 100 years, it was unclear whether healthy older people should take it as a preventive to keep them healthy for longer, he says, adding “aspirin is the most widely used of all preventive drugs and an answer to this question is long overdue”. The findings would help inform prescribing doctors who have been uncertain about recommending aspirin to healthy patients who do not have a clear medical reason for it. The study was funded largely by the United States National Institutes of Health (NIH), the Australian National Health and Medical Council, Victorian Cancer Agency and Monash University. The study would not have been completed without government funding, he says, adding that “usually only drug companies provide the money”. In an environment where conflict-of-interest issues rock the research world as funds are put in by drug companies, McNeil clarified, in this study, that the originator company Bayer only provided the tablets and placebo (an inert pill that does not contain the active drug).

McNeil advices patients to follow their doctor’s advice on aspirin, adding that the findings did 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.

“Aspirin remains a relatively safe medication, but more research was needed to investigate the longer-term benefits and risks of its daily use,” he said, adding that researchers were following the health of participants to determine if benefits, including cancer prevention, emerge from taking the drug over a period of time.

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