Evidence suggests that those without a history of heart attack or stroke shouldn't begin using baby aspirin - Liberty

Friday, July 28, 2023

Evidence suggests that those without a history of heart attack or stroke shouldn't begin using baby aspirin

 A recent study of older adults who have never had a heart attack or stroke reveals that taking daily low-dose aspirin has limited preventive benefits and concerning side effects.


According to new research, healthy older persons should not use low-dose aspirin to prevent their first heart attack or stroke. Alamy/Sara Stathas

Liberty-CNN, A recent study of data from a large clinical trial including healthy older persons revealed no appreciable stroke protection and a greater incidence of brain hemorrhage among those taking daily low-dose aspirin.

The study, which was published on Wednesday in the medical journal JAMA, is the most recent proof that low-dose aspirin, which slows platelet clotting, may not be suitable for persons without a history of heart issues or stroke warning symptoms. The results show that aspirin usage should be especially careful in older adults who are prone to falls that may result in brain bleeds.

The updated information supports the U.S. Preventive Services Task Force's finalized advice from last year that healthy older persons should not use low-dose aspirin to prevent their first heart attack or stroke.

"We can be very emphatic that healthy people who are not on aspirin and do not have multiple risk factors should not be starting it now," said Dr. Randall Stafford, a Stanford University medical professor, and epidemiologist who was not involved in the research.

He conceded, however, that for those who did not meet that criterion, the choice was less obvious.

The murkier it becomes, he added, the longer you've been taking aspirin and the more risk factors you have for heart attacks and strokes.

Daily aspirin should continue to be a crucial component of therapy for the majority of patients who have previously had a heart attack or stroke, according to many cardiac and stroke specialists who participated in interviews.

Aspirin in Reducing Events in the Elderly, or ASPREE, a randomized control study of daily low-dose aspirin among seniors living in Australia and the United States, provided the data for the current research. Adults over 70 who were free of any clinical cardiovascular disease made up 19,114 subjects. (Anyone having a history of a heart attack or stroke was not included in the research.)

To address the challenging balance that clinicians must strike when avoiding clots and bleeding in elderly patients, it sought to highlight subtleties in the data. The justification was that as individuals age, the relative importance of aspirin's risks and advantages may change. Older persons are more likely to get head injuries from falls, and strokes are more common due to blockages and tiny blood arteries that become more brittle with age.

In the trial, 9,525 participants were randomly allocated to take 100 milligrams of aspirin daily, whereas 9,589 others were given identical placebo tablets. Both the groups and the researchers were unaware of who was taking which kind of medication. Participants in the research were followed for a median of 4.7 years.

Although not considerably, aspirin seems to lower the risk of ischemic stroke, or a clot in a blood artery feeding the brain. In contrast to those who received a daily dummy tablet, researchers discovered a substantial increase in cerebral hemorrhage among those who took daily aspirin – 38 percent.

Cardiologists who were not affiliated with the research praised its scope and meticulous methodology, in which experts examined medical data and carefully classified the incidents rather than relying on patient-reported outcomes. However, they pointed out that since stroke rates were low in both groups, it was challenging to extend the findings. There was no examination of cardiac attacks in the article.

Given that the majority of participants were from Australia and that 91 percent of them were white, they also questioned how the results would apply to the varied population of the United States.

Aspirin used to be thought of by some medical professionals as a kind of miracle medication that might shield healthy individuals from having another heart attack or stroke. However, new research has shown that the potent medication has a limited preventive effect in those who have not yet had such a catastrophe and has potentially harmful side effects.

Due to the possibility of internal bleeding, the U.S. Preventive Services Task Force advised last year against starting low-dose aspirin therapy in the majority of individuals who have never had a heart attack or stroke. In a swiftly issued follow-up statement, the American College of Cardiology reiterated that the advice "does not apply to patients with a prior history of heart attack, stroke, bypass surgery, or recent stent procedure."

However, several stroke victims seemed to misunderstand the instructions. Several cardiologists said in interviews that patients who obviously required aspirin have stopped taking it suddenly only to get a second stroke and end up in the emergency department.

They advised that no one should ever discontinue taking aspirin without first talking to a doctor.

According to Dr. Shlee S. Song, head of the Comprehensive Stroke and Telestroke Programs at Cedars-Sinai, "When a study comes out, you have to ask yourself, how well do I fit into this study's population?" The results of this research do not apply to you if you have ever had a heart attack or stroke.

Dr. Song, who is in charge of the stroke programs at four hospitals in Los Angeles, warned patients not to stop taking the medication in an interview last year. She said that despite the research, she was still the same.

"There's a lot of noise out there," she remarked. At the end of the day, these issues need to be explored with a doctor who is familiar with your particular case.

The risk-benefit analysis would also vary for each patient, depending on how long they had been taking aspirin and why their doctor had initially recommended the drug, according to Dr. Joshua Willey, an associate professor of neurology and a stroke specialist at Columbia University Vagelos College of Physicians and Surgeons. A physician may come to the conclusion that aspirin has preventative benefits that outweigh the patient's risk of bleeding for a patient who has a high chance of developing another ailment, such as colorectal cancer.

The research results, he added, have a distinct meaning for clinicians treating patients who must continue taking aspirin: "Check their balance, get them physical therapy, make sure the home is set up appropriately. In that Medicare age range, take whatever precautions you can to reduce the chance of falling.
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