Daily low-dose aspirin found to have no effect on healthy life span in older people

Credit: CC0 Public Domain

In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (life free of dementia or persistent physical disability). Risk of dying from a range of causes, including cancer and heart disease, varied and will require further analysis and additional follow-up of study participants. These initial findings from the ASPirin in Reducing Events in the Elderly (ASPREE) trial, partially supported by the National Institutes of Health, were published online on September 16, 2018 in three papers in The New England Journal of Medicine.

05 nov 2018--ASPREE is an international, randomized, double-blind, placebo-controlled trial that enrolled 19,114 older people (16,703 in Australia and 2,411 in the United States). The study began in 2010 and enrolled participants aged 70 and older; 65 was the minimum age of entry for African-American and Hispanic individuals in the United States because of their higher risk for dementia and cardiovascular disease. At study enrollment, ASPREE participants could not have dementia or a physical disability and had to be free of medical conditions requiring aspirin use. They were followed for an average of 4.7 years to determine outcomes.
"Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease," said NIA Director Richard J. Hodes, M.D. "The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. This study shows why it is so important to conduct this type of research, so that we can gain a fuller picture of aspirin's benefits and risks among healthy older persons."
The team of scientists was led by John J. McNeil, M.B.B.S., Ph.D., head of the Department of Epidemiology and Preventive Health at Monash University, Melbourne, Australia, and Anne M. Murray, M.D., director of the Berman Center for Outcomes and Clinical Research at Hennepin Healthcare in Minneapolis. The research was supported in part by the National Institute on Aging (NIA) and the National Cancer Institute (NCI), both parts of the NIH. The Australian component of the study also received funding from the Australian National Health and Medical Research Council and Monash University. Aspirin and placebo were supplied by Bayer, which had no other involvement with the study.
In the total study population, treatment with 100 mg of low-dose aspirin per day did not affect survival free of dementia or disability. Among the people randomly assigned to take aspirin, 90.3 percent remained alive at the end of the treatment without persistent physical disability or dementia, compared with 90.5 percent of those taking a placebo. Rates of physical disability were similar, and rates of dementia were almost identical in both groups.
The group taking aspirin had an increased risk of death compared to the placebo group: 5.9 percent of participants taking aspirin and 5.2 percent taking placebo died during the study. This effect of aspirin has not been noted in previous studies; and caution is needed in interpreting this finding. The higher death rate in the aspirin-treated group was due primarily to a higher rate of cancer deaths. A small increase in new cancer cases was reported in the group taking aspirin but the difference could have been due to chance.
The researchers also analyzed the ASPREE results to determine whether cardiovascular events took place. They found that the rates for major cardiovascular events—including coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic stroke—were similar in the aspirin and the placebo groups. In the aspirin group, 448 people experienced cardiovascular events, compared with 474 people in the placebo group.
Significant bleeding—a known risk of regular aspirin use—was also measured. The investigators noted that aspirin was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract and brain. Clinically significant bleeding—hemorrhagic stroke, bleeding in the brain, gastrointestinal hemorrhages or hemorrhages at other sites that required transfusion or hospitalization—occurred in 361 people (3.8 percent) on aspirin and in 265 (2.7 percent) taking the placebo.
As would be expected in an older adult population, cancer was a common cause of death, and 50 percent of the people who died in the trial had some type of cancer. Heart disease and stroke accounted for 19 percent of the deaths and major bleeding for 5 percent.
"The increase in cancer deaths in study participants in the aspirin group was surprising, given prior studies suggesting aspirin use improved cancer outcomes," said Leslie Ford, M.D., associate director for clinical research, NCI Division of Cancer Prevention. "Analysis of all the cancer-related data from the trial is under way and until we have additional data, these findings should be interpreted with caution."
"Continuing follow-up of the ASPREE participants is crucial, particularly since longer term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date," said Evan Hadley, M.D., director of NIA's Division of Geriatrics and Clinical Gerontology. "These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants."
As these efforts continue, Hadley emphasized that older adults should follow the advice from their own physicians about daily aspirin use. It is important to note that the new findings do not apply to people with a proven indication for aspirin such as stroke, heart attack or other cardiovascular disease. In addition, the study did not address aspirin's effects in people younger than age 65. Also, since only 11 percent of participants had regularly taken low-dose aspirin prior to entering the study, the implications of ASPREE's findings need further investigation to determine whether healthy older people who have been regularly using aspirin for disease prevention should continue or discontinue use.

More information: Abstract/Full Text 1
Abstract/Full Text 2
Abstract/Full Text 3


Provided by National Institutes of Health

Aspirin disappoints for avoiding first heart attack, stroke

This Thursday, Aug. 23, 2018 photo shows an arrangement of aspirin pills in New York. New studies find most people won't benefit from taking daily low-dose aspirin or fish oil supplements to prevent a first heart attack or stroke. Results were discussed Sunday, Aug. 26, 2018, at the European Society of Cardiology meeting in Munich. (AP Photo/Patrick Sison)

Taking a low-dose aspirin every day has long been known to cut the chances of another heart attack, stroke or other heart problem in people who already have had one, but the risks don't outweigh the benefits for most other folks, major new research finds.

27 aug 2018--Although it's been used for more than a century, aspirin's value in many situations is still unclear. The latest studies are some of the largest and longest to test this pennies-a-day blood thinner in people who don't yet have heart disease or a blood vessel-related problem.
One found that aspirin did not help prevent first strokes or heart attacks in people at moderate risk for one because they had several health threats such as smoking, high blood pressure or high cholesterol.
Another tested aspirin in people with diabetes, who are more likely to develop or die from heart problems, and found that the modest benefit it gave was offset by a greater risk of serious bleeding.
Aspirin did not help prevent cancer as had been hoped.
And fish oil supplements, also tested in the study of people with diabetes, failed to help.
"There's been a lot of uncertainty among doctors around the world about prescribing aspirin" beyond those for whom it's now recommended, said one study leader, Dr. Jane Armitage of the University of Oxford in England. "If you're healthy, it's probably not worth taking it."
The research was discussed Sunday at the European Society of Cardiology meeting in Munich. The aspirin studies used 100 milligrams a day, more than the 81-milligram pills commonly sold in the United States but still considered low dose. Adult strength is 325 milligrams.

WHO'S REALLY AT RISK?

A Boston-led study gave aspirin or dummy pills to 12,546 people who were thought to have a moderate risk of suffering a heart attack or stroke within a decade because of other health issues.
After five years, 4 percent of each group had suffered a heart problem—far fewer than expected, suggesting these people were actually at low risk, not moderate. Other medicines they were taking to lower blood pressure and cholesterol may have cut their heart risk so much that aspirin had little chance of helping more, said the study leader, Dr. J. Michael Gaziano of Brigham and Women's Hospital.
One percent of aspirin takers had stomach or intestinal bleeding, mostly mild— twice as many as those on dummy pills. Aspirin users also had more nosebleeds, indigestion, reflux or belly pain.
Bayer sponsored the study, and many researchers consult for the aspirin maker. Results were published by the journal Lancet.

ASPIRIN FOR PEOPLE WITH DIABETES?

People with diabetes have a higher risk of heart problems and strokes from a blood clot, but also a higher risk of bleeding. Guidelines vary on which of them should consider aspirin.
Oxford researchers randomly assigned 15,480 adults with Type 1 or 2 diabetes but otherwise in good health and with no history of heart problems to take either aspirin, 1 gram of fish oil, both substances, or dummy pills every day.
After seven and a half years, there were fewer heart problems among aspirin users but more cases of serious bleeding, so they largely traded one risk for another.

FISH OIL RESULTS

The same study also tested omega-3 fatty acids, the good oils found in salmon, tuna and other fish. Supplement takers fared no better than those given dummy capsules—9 percent of each group suffered a heart problem.
"We feel very confident that there doesn't seem to be a role for fish oil supplements for preventing heart disease," said study leader Dr. Louise Bowman of the University of Oxford.
The British Heart Foundation was the study's main sponsor. Bayer and Mylan provided aspirin and fish oil, respectively. Results were published by the New England Journal of Medicine.
Other studies are testing different amounts and prescription versions of fish oil, "but I can't tell people go spend your money on it; we think it's probably better to eat fish," said Dr. Holly Andersen, a heart disease prevention specialist at New York-Presbyterian/Weill Cornell who was not involved in the study.
The new research doesn't alter guidelines on aspirin or fish oil, said Dr. Nieca Goldberg, a cardiologist at NYU Langone Medical Center and an American Heart Association spokeswoman. They recommend fish oil only for certain heart failure patients and say it's reasonable to consider for people who have already suffered a heart attack.

Review finds no benefit to aspirin for preserving cognitive function

An analysis of published studies found no evidence that low- dose aspirin buffers against cognitive decline or dementia or improves cognitive test scores.

21 april 2017--The review and meta-analysis included eight studies with 36,196 participants who were an average of 65 years old and did not have cognitive impairment at baseline. Participants were followed for an average of six years.
"Additional studies are needed to test the possibility that low-dose aspirin has beneficial effects when taken over a longer period and at an earlier age," said Dr. Nicola Veronese, lead author of the Journal of the American Geriatrics Society study.

More information: Nicola Veronese et al, Low-Dose Aspirin Use and Cognitive Function in Older Age: A Systematic Review and Meta-analysis, Journal of the American Geriatrics Society (2017). DOI: 10.1111/jgs.14883

Aspirin cuts risk of clots, DVT by a third, new study finds

 

Coated aspirin tablets. Image: Wikimedia Commons.

Low dose aspirin lowers the occurrence of new venous blood clots – and represents a reasonable treatment option for patients who are not candidates for long-term anticoagulant drugs, such as warfarin, according to a new study published in today's issue of Circulation.

28 aug 2014--"The study provides clear, consistent evidence that low-dose aspirin can help to prevent new venous blood clots and other cardiovascular events among people who are at risk because they have already suffered a blood clot," says the study's lead author, University of Sydney Professor, John Simes.

"The treatment effect of aspirin is less than can be achieved with warfarin or other new generation direct thrombin inhibitors, which can achieve more than an 80 per cent reduction in adverse circulatory and cardiopulmonary events.

"However, aspirin represents a useful treatment option for patients who are not candidates for anticoagulant drugs because of the expense or the increased risk of bleeding associated with anticoagulants."

Key results

Compared to placebo patients, those who took 100mg daily of aspirin had a one-third reduction in the risk of:

• thromboembolism, which is the obstruction of a blood vessel by a clot that has dislodged from another site in the circulation.
• deep vein thrombosis (DVT), which is the formation of a blood clot in a deep vein, predominantly in the legs.
• pulmonary embolism, which is a blood clot affecting the arteries that supply blood to the lungs.
• myocardial infarction (heart attack), stroke or cardiovascular death.

Most people who have had a blood clot in a leg vein (deep-vein thrombosis) or an embolism (where the clot blocks the blood flow) have anticoagulant drug treatment (such as warfarin) for at least 6 months, first to dissolve the clot and then to prevent it happening again.

However, long-term anticoagulant drugs are expensive and inconvenient, requiring frequent regular blood tests and adjustments to the dosage. Further, there is an elevated risk that the treatment could cause bleeding in some patients. For people who are not able to cope with this, the viable alternative of taking regular aspirin will be a great benefit.

"The study provides evidence that after a first venous thrombosis or embolism, daily aspirin reduces the risk of another event, without causing undue bleeding. This treatment is an alternative to long-term anticoagulation and will be especially useful for patients who do not want the inconvenience of close medical monitoring or the risk of bleeding," says Professor Simes.

"Aspirin will be ideal in the many countries where prolonged anticoagulant treatment is too expensive. A major benefit of this treatment is its cost-effectiveness. Aspirin is cheap, but it will save the treatment costs of the many recurrent clots that are prevented. This could mean a saving of millions of healthcare dollars worldwide."

Co-investigator Tim Brighton, a senior haematologist at Sydney's Prince of Wales Hospital, adds: "This important study demonstrates clearly that low-dose aspirin reduces the risks of further blood clot. This is especially important for patients who are not able to take long-term anticoagulant medications for whatever reason, such as personal preference, adverse effects of anticoagulant or cost."

Provided by University of Sydney

Aspirin may slow the decline in mental capacity among elderly patients

A daily dose of acetylsalicylic acid equivalent to a fourth of an aspirin may slow the decline in intellectual capacity among elderly individuals with high cardiovascular risk. This is shown in a study by Sahlgrenska Academy, University of Gothenburg, Sweden.

31 oct 2012--Researchers at Sahlgrenska Academy, University of Gothenburg, over a five year period studied how intellectual capacity changes among 681 elderly women (70 to 92 years) with heightened risk of suffering from a heart attack, vascular spasm or stroke.

Of the 681 women, 129 received a low daily dose of acetylsalicylic acid, equivalent to a fourth of an aspirin, to prevent heart disease. The Gothenburg study shows that acetylsalicylic acid also slowed decline in brain capacity among the elderly women.

In the study, published in British Medical Journal Open, the women underwent various tests to measure their physical health and intellectual capacity, such as language and memory tests.

"At the end of the five year examination period mental capacity had declined among all the women and the portion that suffered from dementia was equally large in the entire group. However, the decline in brain capacity was significantly less and occurred at a slower pace among the women who received acetylsalicylic acid," says Silke Kern, researcher at Sahlgrenska Academy.

The effect remained even when age, genetic factors and use of anti-inflammatory drugs were taken into account.

In addition to preventing heart disease, acetylsalicylic acid has been shown to be effective against cancer according to several scientific studies. It is common practice in many countries to treat women at risk for heart disease with a small dose of acetylsalicylic acid – but not in Sweden.

Silke Kern emphasizes that the study is an observational study and that more research is necessary before any definitive conclusions can be made.

"Our results indicate that acetylsalicylic acid may protect the brain, at least among women at high risk for a heart attack or stroke. However, we do not know the long term effects of routine treatment. We certainly do not want to encourage the elderly to self-medicate with aspirin to avoid dementia," she states.

The research group in Gothenburg has now started a follow-up study that will follow the older women for an additional five years.

More information: The study Does low-dose acetylsalicylic acid prevent cognitive decline in women with high cardiovascular risk? A 5-year follow-up of a non-demented population-based cohort of Swedish elderly women was published in BJM Open on October 3, 2012.bmjopen.bmj.com/co… e001288.long

Provided by University of Gothenburg

Aspirin may temper brain power decline in elderly women at risk of heart disease

Daily low dose aspirin could slow the decline in brain power among elderly women at high risk of heart disease, indicates observational research published in the online journal BMJ Open.

06 oct 2012--The researchers base their findings on 681 women between the ages of 70 and 92, 601 of whom were at high risk of heart disease and stroke, defined as a 10% or greater risk on a validated risk scale (Framingham).

All the women were subjected to a battery of tests to measure their physical health and intellectual capacity, including verbal fluency and memory speed, and dementia (mini mental state exam, or MMSE for short) in 2000-1.

Their health was tracked over a period of five years, at the end of which the intellectual capacity of 489 women was assessed again.

Some 129 women were taking low dose aspirin (75 to 160 mg) every day to ward off a heart attack or stroke when the monitoring period started. A further 94 were taking various other non-steroidal anti-inflammatory drugs (NSAIDs).

The MMSE score fell, on average, across the whole group at the end of the five years, but this decline was considerably less in the 66 women who had taken aspirin every day over the entire period.

This held true, even after taking account of age, genetic factors, the use of other NSAIDs, and the cardiovascular risk score.

The researchers then divided up the group into those who had taken aspirin for the entire five years (66); those who had stopped taking it by 2005-6 (18); those who were taking it by 2005-6 (67); and those who hadn't taken the drug at any point (338).

Compared with women who had not taken aspirin at all, those who had done so for all five years, increased their MMSE score, while those who had taken aspirin at some point, registered only insignificant falls in MMSE score.

The test results for verbal fluency and memory speed indicated similar patterns, although the findings weren't statistically significant.

There were no differences, however, in the rate at which the women developed dementia.

The researchers then looked only at the women with a Framingham risk score of more than 10%. Again, similar patterns were evident.

The fall in MMSE score was less among those taking aspirin than those who weren't, and there was no difference between those taking other NSAIDs and those who weren't. The same was true of the verbal and memory tests, although the differences were not statistically significant.

The authors caution that theirs was an observational study, and that the MMSE can't detect subtle changes in cognitive ability. But they suggest their findings indicate that aspirin may protect the brain—at least in women at high risk of a heart attack or stroke.

Provided by British Medical Journal

Low-dose aspirin reduces death rates from range of cancers by between 20 and 30 percent

The London School of Hygiene & Tropical Medicine (LSHTM) has contributed to a study showing that a low dose of aspirin reduces the occurrence of several common cancers. The study is published in today's Lancet.

08 dec 2010--The work was started and carried out by Professor Peter Rothwell in Oxford, and is based on an overview of several randomised trials of aspirin. These have been primarily concerned with reducing heart attacks, but have also gathered information on deaths from cancer.

The trial contributing most information to the overview has been the Thrombosis Prevention Trial (funded jointly by the Medical Research Council and the British Heart Foundation) which was carried out by Tom Meade when he was with the Medical Research Council. Professor Meade is now Emeritus Professor of Epidemiology in LSHTM's Department of Non-Communicable Disease Epidemiology.

As well as confirming that low dose aspirin reduces large bowel cancer cases reported in another recent study also led by Professor Rothwell and to which Professor Meade contributed, it also reduces total deaths due to cancer because it affects several common individual cancers, such as those of the oesophagus (gullet), lung, stomach, pancreas and possibly the brain. Reductions in deaths are around 20-30%.

Benefit is unrelated to aspirin dose from 75mg upwards, gender or smoking habit but increases with age. Aspirin may need to be taken for at least five years before it confers benefit, probably longer for some cancers, but benefit is generally greater the longer aspirin has been taken.

Hitherto, advice about aspirin has been mainly concerned with reducing heart attacks and strokes in those who have already had them. Caution should be exercised by those who are so far free of these conditions because, unless a person's risk of them is very high, the benefit may be outweighed by the risk of serious bleeding.

Professor Meade says: 'These are very exciting and potentially important findings. They are likely to alter clinical and public health advice about low dose aspirin because the balance between benefit and bleeding has probably been altered towards using it', although Professor Meade adds that this does not mean everyone should automatically take aspirin. Health professionals and others will now have to consider the practical implications.

Provided by London School of Hygiene & Tropical Medicine

Aspirin After Cancer Diagnosis Linked to Lower Mortality

Drug linked to survival after colorectal cancer, especially in tumors overexpressing COX-2

13 aug 2009-- The use of aspirin after the diagnosis of colorectal cancer -- especially tumors overexpressing cycooxygenase-2 (COX-2) -- may be associated with better survival, according to research published in the Aug. 12 issue of the Journal of the American Medical Association.

Andrew T. Chan, M.D., of the Massachusetts General Hospital in Boston, and colleagues analyzed data from 1,279 participants in the Nurses' Health Study and the Health Professionals Follow-up Study diagnosed with stages I, II, or III colorectal cancer, who were followed for a median 11.8 years after diagnosis. Subjects provided information on their aspirin use, and investigators assessed COX-2 expression in many of the subjects' primary tumors.

The researchers found that subjects who regularly took aspirin after their diagnosis had a lower risk of colorectal cancer-specific mortality (multivariate hazard ratio, 0.71) and overall mortality (multivariate hazard ratio, 0.79), compared to nonusers. Aspirin use after diagnosis was associated with lower risk of colorectal cancer-specific mortality in those whose primary tumors overexpressed COX-2 (multivariate hazard ratio, 0.39), but not in those with COX-2-negative tumors.

"The survival benefits of aspirin were similar in patients who received standard adjuvant chemotherapy and those who did not, and in patients with stage I and stage II disease as well as those who had stage III disease at diagnosis. Thus, aspirin may have the potential to be useful as adjuvant therapy not just for locally advanced disease but for early stage patients as well," writes the author of an accompanying editorial.

Abstract
Full Text (subscription or payment may be required)
Editorial (subscription or payment may be required)

Anti-clot drug combinations boost

CHICAGO, 04 june 2009-- Heart patients are often given two or three different drugs to prevent life-threatening blood clots but these combinations can double, triple or even quadruple the risk of stomach or intestinal bleeding, U.S. researchers said on Tuesday.

Clot-preventing drugs such as aspirin, warfarin or Coumadin and clopidogrel or Plavix sold by Bristol-Myers Squibb and Sanofi-Aventis are increasingly being given to heart patients in combinations.

"They are often prescribed to prevent that second event -- that heart attack or stroke," Dr. Neena Abraham of Baylor College of Medicine in Houston, Texas, told reporters at the Digestive Disease Week meeting in Chicago.

"However, each of these drugs independently is associated with a high risk of clinically significant upper gastrointestinal events, which are defined as ulcers of the stomach or intestines, bleeding or perforations," she said.

"These drugs are commonly prescribed in combination; however, the magnitude of the risk of using these drugs on the gastrointestinal tract remains relatively unknown."

To study this, Abraham and colleagues used national pharmacy data and medical records from the Veterans Affairs Department to identify people aged 60 to 99 who had been given four combinations of clot-preventing drugs.

Some got aspirin and an antiplatelet drug like Plavix that keeps blood platelets from forming clots. Others got an antiplatelet drug and an anticoagulant such as warfarin, which keeps the liver from making certain clotting factors. Some got aspirin and warfarin. And some got all three.

Of the more than 78,000 patients studied, 30.4 percent were prescribed some combination of anticlotting drugs, and 1,061 of these had bleeding events that needed immediate medical attention within the first year.

RISING RISK

"When we compared the risk of bleeding from these different combinations, what we see is a stepwise increase in risk," Abraham said.

The dual combination of an anticoagulant and antiplatelet drug, which proved to be least harmful, raised the risk of a serious bleeding problem within one year by 70 percent.

A combination of an aspirin and antiplatelet drug doubled the risk, while an aspirin-anticoagulant combination tripled the one-year bleeding risk.

And patients who got all three drugs had a four-fold increase in the risk of gastrointestinal bleeding within one year, Abraham said.

"These are significant gastrointestinal bleeding risks."

Abraham said triple therapy was most commonly given to younger patients in the study -- those aged 60 and 69 years of age -- and likely reflected recent changes in cardiac care.

She said the findings suggest the need for a careful balancing of the risks and benefits of these drugs.

Heart patients on triple therapy may want to ask their doctor about dropping down to a dual or single therapy.

"We know they are healthy for the heart at preventing strokes and heart attacks, but what physicians now need to consider is short-term potential risks of GI bleeding versus the potential long-term benefits of being on these protective drugs," she said.

Anti-clot drug combinations boost bleeding risks

CHICAGO, 03 june 2009- - Heart patients are often given two or three different drugs to prevent life-threatening blood clots but these combinations can double, triple or even quadruple the risk of stomach or intestinal bleeding, U.S. researchers said on Tuesday.

Clot-preventing drugs such as aspirin, warfarin or Coumadin and clopidogrel or Plavix sold by Bristol-Myers Squibb and Sanofi-Aventis are increasingly being given to heart patients in combinations.

"They are often prescribed to prevent that second event -- that heart attack or stroke," Dr. Neena Abraham of Baylor College of Medicine in Houston, Texas, told reporters at the Digestive Disease Week meeting in Chicago.

"However, each of these drugs independently is associated with a high risk of clinically significant upper gastrointestinal events, which are defined as ulcers of the stomach or intestines, bleeding or perforations," she said.

"These drugs are commonly prescribed in combination; however, the magnitude of the risk of using these drugs on the gastrointestinal tract remains relatively unknown."

To study this, Abraham and colleagues used national pharmacy data and medical records from the Veterans Affairs Department to identify people aged 60 to 99 who had been given four combinations of clot-preventing drugs.

Some got aspirin and an antiplatelet drug like Plavix that keeps blood platelets from forming clots. Others got an antiplatelet drug and an anticoagulant such as warfarin, which keeps the liver from making certain clotting factors. Some got aspirin and warfarin. And some got all three.

Of the more than 78,000 patients studied, 30.4 percent were prescribed some combination of anticlotting drugs, and 1,061 of these had bleeding events that needed immediate medical attention within the first year.

RISING RISK

"When we compared the risk of bleeding from these different combinations, what we see is a stepwise increase in risk," Abraham said.

The dual combination of an anticoagulant and antiplatelet drug, which proved to be least harmful, raised the risk of a serious bleeding problem within one year by 70 percent.

A combination of an aspirin and antiplatelet drug doubled the risk, while an aspirin-anticoagulant combination tripled the one-year bleeding risk.

And patients who got all three drugs had a four-fold increase in the risk of gastrointestinal bleeding within one year, Abraham said.

"These are significant gastrointestinal bleeding risks."

Abraham said triple therapy was most commonly given to younger patients in the study -- those aged 60 and 69 years of age -- and likely reflected recent changes in cardiac care.

She said the findings suggest the need for a careful balancing of the risks and benefits of these drugs.

Heart patients on triple therapy may want to ask their doctor about dropping down to a dual or single therapy.

"We know they are healthy for the heart at preventing strokes and heart attacks, but what physicians now need to consider is short-term potential risks of GI bleeding versus the potential long-term benefits of being on these protective drugs," she said.

Value of Taking Aspirin to Cut Heart Risk Varies

01 june 2009--Taking aspirin reduces heart attack risk in people with no previous history of vascular disease but increases the risk of internal bleeding, say British researchers who analyzed the results of 22 clinical trials.

This means the net effect in this group of patients is uncertain because the benefits and risks may cancel each other out. However, the researchers found that aspirin's benefits generally outweigh its risks among people who have vascular disease.

Colin Baigent, of the University of Oxford, and colleagues looked at serious vascular events (heart attack, stroke or vascular death) among 95,000 low-risk patients in six primary prevention trials and among 17,000 high-risk patients in 16 secondary prevention trials.

Among patients in the primary prevention trials, aspirin was found to reduce the risk of serious vascular events by 12 percent but increased the risk of internal bleeding by about one-third. Among patients in the secondary prevention studies -- who were already at high risk because they had previously experienced a stroke or heart attack -- aspirin reduced the risk of serious vascular events by about one-fifth, a benefit that outweighed the small additional risk of bleeding, the researchers said.

The results in both sets of trials were similar for men and women.

"The currently available trial results do not seem to justify general guidelines advocating the routine use of aspirin in all healthy individuals above a moderate level of risk for coronary heart disease," the study authors wrote in the May 30 issue of The Lancet.

"Drug safety really matters when making recommendations for tens of millions of healthy people," Baigent said in a news release. "We don't have good evidence that, for healthy people, the benefits of long-term aspirin exceed the risks by an appropriate margin. If effectiveness is uncertain, then cost-effectiveness calculations are irrelevant."

Study compares formulations of 3 aspirin types

Study asks, 'Which of the many different types of aspirin is likely to help the most?'

17 may 2009--For many years, it has been known that aspirin is beneficial to patients suffering heart attacks and near-heart attacks. But which of the many different types of aspirin is likely to help the most?

A group of researchers led by Dr. Sean Nordt from the University of California, San Diego gave three different types of aspirin to a group of volunteer research subjects: regular aspirin swallowed whole, regular aspirin chewed and swallowed, and chewable aspirin chewed and swallowed. Blood levels of aspirin were then measured, to see which route led to the highest aspirin levels in the body.

The chewable aspirin consistently showed greater and more rapid absorption than the regular aspirin, whether swallowed whole or chewed. This seemingly quite simple finding could lead to improvements in the care of heart attack patients.

###

The presentation, entitled "Comparison Of Three Aspirin Formulations" will be given by Dr. Sean Nordt in the Cardiovascular forum at the 2009 SAEM Annual Meeting at the Sheraton New Orleans on Friday, May 15 at 1:00 PM. Abstracts are published in Vol. 16, No. 4, Supplement 1, April 2009 of Academic Emergency Medicine, the official journal of the Society for Academic Emergency Medicine.

AEM is a peer-reviewed journal whose goal is to advance the science, education, and clinical practice of emergency medicine, to serve as a voice for the academic emergency medicine community, and to enhance the goals and objectives of the Society for Academic Emergency Medicine (SAEM). Members and non-members worldwide depend on this journal for translational medicine relevant to emergency medicine, in addition to clinical news, case studies and more.

Aspirin recommendation underscores need for physicians and patients to discuss benefits and risk

American College of Preventive Medicine applauds task force for improving guidelines

Washington, DC, 20 mar 2009 – The President of the American College of Preventive Medicine commended the U.S. Preventive Services Task Force (USPSTF) today for its recommendations on aspirin use for primary prevention of heart attack and stroke, released in the March 17 issue of the Annals of Internal Medicine, citing its improved specificity over previous guidelines.

The task force recommends aspirin use for prevention of cardiovascular disease when the benefits clearly outweigh the risks or harms. The task force found that men between the ages of 45 and 79 should use aspirin to reduce their risk for heart attacks when the benefits outweigh the harms for potential gastrointestinal bleeding; and that women between the ages of 55 and 79 should use aspirin to reduce their risk for ischemic stroke when the benefits outweigh the harms for potential gastrointestinal bleeding. The task force also recommended against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years.

"The task force has taken positive steps to lend clarity to patients and physicians about the value of aspirin for prevention of cardiovascular events," says ACPM President Mark B. Johnson, MD, MPH, FACPM. "The new guidelines make it clear that physicians, as a matter of routine practice, should be discussing the pros and cons of daily aspirin use with patients in the target groups."

An ACPM-sponsored survey published in the May 2007 edition of the American Journal of Preventive Medicine found a conversation between the patient and physician to be the strongest predictor of appropriate aspirin use, and that only about one in three patients who are at high risk are actually taking daily aspirin. A separate study by the Partnership for Prevention found that 45,000 lives could be saved each year if 90% of the target population took a low-dose aspirin every day. These studies led the American Medical Association to adopt a policy to increase education among physicians on the importance of appropriate aspirin counseling.

With today's release, the USPSTF updates its aspirin recommendations from 2002, which called on clinicians to discuss aspirin use for primary prevention with adults who are at increased risk for cardiovascular disease. The new USPSTF findings actually recommend aspirin use where benefits outweigh the harms, and further define the appropriate age and gender groupings for which aspirin is indicated.

"We think the new guidelines provide another tool in the armamentarium of the physician and the patient for assuring that a discussion about cardiovascular risk and potential aspirin use routinely takes place in the clinical setting," says David Shih, MD, MS, ACPM senior director of medical affairs. ACPM is leading the development of the national initiative, "Aspirin Talks: Start a Life-Saving Conversation," whose goal is to improve appropriate aspirin use to prevent heart attacks and strokes. Under the initiative ACPM is developing and testing an office-level intervention designed to help clinicians engage in a conversation about aspirin, featuring a tool kit with physician, patient, and clinic aids to facilitate aspirin therapy counseling.

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More information about ACPM's aspirin initiative can be found at http://www.acpm.org/aspirin/. To view the USPSTF recommendation, visit http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm.

Aspirin does not prevent heart attacks in patients with diabetes

The prevention of progression of arterial disease and diabetes: a factorial randomized placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease

Taking regular aspirin and antioxidant supplements does not prevent heart attacks even in high risk groups with diabetes and asymptomatic arterial disease, and aspirin should only be given to patients with established heart disease, stroke or limb arterial disease, according to a study published today on bmj.com.
In light of these findings, and the evidence from six other well controlled trials, the prescribing practice of doctors and international guidelines should be reviewed so that aspirin is only prescribed to patients with established heart and stroke disease, argues the author of an accompanying editorial.
Patients with diabetes are two to five times more likely to suffer from heart disease than the general population and heart disease is a major cause of death in patients with type 1 and 2 diabetes. Although there is considerable evidence showing no protective benefit of aspirin in high risk patients without heart disease, guidelines are inconsistent and aspirin is commonly prescribed for the primary prevention of heart disease in patients with diabetes and with peripheral arterial disease.
But aspirin is one of the top 10 causes of adverse drug events reported to the Commission on Human Medicines. It causes gastrointestinal bleeding and the risk of bleeding increases with age and prolonged use.
Professor Jill Belch and colleagues from Scotland investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease. 1276 patients with diabetes and evidence of artery disease over 40 years of age were randomised to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant or double placebo, and followed over eight years.
Overall, the researchers found no benefit from either aspirin or antioxidant treatment in the prevention of heart attacks or death. Patients in the aspirin groups had 116 primary events compared with 117 in the placebo group. No significant difference in events was seen between the antioxidant group and the placebo group.
The authors conclude by voicing their concern at the widespread prescribing of aspirin despite the lack of evidence to support its use in the primary prevention of heart attacks and death in people with diabetes and in view of its possible side effects.
These findings show that unlike statins and drugs for reducing hypertension, which have a benefit in all risk groups including those with and without heart disease, only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin, writes Professor William Hiatt in an accompanying editorial.
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Contacts:
Professor Jill Belch, Institute of Cardiovascular Research, University of Dundee, Dundee, Scotland. Tel: +44 (0)1382 632 457 Email: j.j.f.belch@dundee.ac.uk

How aspirin could help women fight asthma

By JENNY HOPE
Taking a low dose of aspirin every other day could ward off asthma for women, say researchers.
A study found that a group of older women taking aspirin regularly developed 10 per cent fewer new cases than expected.
It is the latest in a string of discoveries of beneficial effects from the drug, which has been shown to cut the risk of heart attacks, stroke, some cancers and dementia.
More than five million Britons suffer from asthma, which claims 1,400 lives a year here.
The American study, detailed in the medical journal Thorax, was based on monitoring the health of 40,000 women of 45 and over.
They were randomly assigned to take either 100mg of aspirin every other day or a placebo.
In the group taking aspirin 872 new cases were diagnosed compared with 963 among those taking a placebo.
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The effect persisted even after taking account of factors such as age and smoking, although aspirin did not lessen the risk in obese women.
Study leader Dr Tobias Kurth, from Brigham and Women's Hospital in Massachusetts, said the biological mechanism involved was unknown and further trials were necessary.
The team warned that existing asthma patients would not benefit.
Previous research in male doctors found aspirin cut the risk of asthma by 22 per cent.
For all its benefits, aspirin can have side effects ranging from dizziness to stomach pain and bleeding.
Some people are hypersensitive to it and cannot tolerate even small amounts.
It may also be unsuitable for people with uncontrolled high blood pressure, liver or kidney disease, peptic ulcer or conditions that may cause internal bleeding.

Full-Strength Aspirin Over Time Has Ambiguous Effect on Cancer Risk

ATLANTA, April 10 -- Five years or more of daily adult-strength aspirin is associated with modest protection against colorectal, prostate, and breast cancers, investigators here reported.
However, daily low-dose aspirin (81 mg) used for cardiovascular protection is not associated with any additional protection against cancer, in keeping with other studies, reported Eric J. Jacobs, Ph.D., of the American Cancer Society, and colleagues, in the April 18 issue of the Journal of the National Cancer Institute.
The five-year findings emerged from a huge observational survey. But the investigators cautioned that a decade or longer will be needed to determine whether the association they found matters. At the moment, they wrote, "our results do not have immediate clinical implications."
In an accompanying editorial, María Elena Martínez, M.P.H., Ph.D., of the University of Arizona in Tucson, and E. Robert Greenberg, M.D., of Dartmouth Medical College in Hanover, N.H., pointed out that chronic use of full-strength aspirin (325 mg) may also have GI and hematologic consequences that obviate any potential anticancer benefit that may emerge in a long-term trial.
"Although such a trial merits careful consideration, it might be difficult to conduct it among average-risk individuals, given the toxicity of aspirin at doses greater than 80 mg/day," they wrote. "Thus, the authors appear justified in concluding that their results do not have immediate clinical implications, but they clearly illustrate the potential future importance of aspirin and other anti-inflammatory interventions as cancer control strategies."

Aspirin underutilized for heart attack prevention

Tue Apr 10, 2007 12:42PM EDT
By Megan Rauscher
NEW YORK (Reuters Health) - Although it's well known that taking aspirin regularly can lower a person's risk of heart disease, few Americans, it seems, use the common pain reliever for heart health.
A new study finds that use of aspirin for the prevention of a first or second heart attack or stroke is very low, even among adults at increased risk for such events.
Among a nationally representative sample of 1,299 Americans aged 40 or older, overall only 41 percent reported regular aspirin use for cardiovascular prevention.
Only 57 percent of people considered at increased risk for cardiovascular events said they took aspirin regularly.
"Even for those with a known history of cardiovascular disease, aspirin use was only 69 percent," according to a report on the survey in the May issue of the American Journal of Preventive Medicine.

http://www.reuters.com/article/healthNews/idUSCOL05954420070410?feedType=RSS

Low-Dose Aspirin Therapy Effective After Heart Surgery

Major bleeding was noticeably reduced after 8 months, Canadian study finds
SATURDAY, March 24 (HealthDay News) -- Low-dose aspirin therapy may be as effective as high-dose therapy in preventing blood clots, while reducing the risk of bleeding in heart patients who've had treatments such as angioplasty or stenting, Canadian researchers say.
The patients included in the study had what doctors call "acute coronary syndromes" (ACS) -- a group of symptoms linked to chest pain caused by arterial damage. These patients are at high risk for heart attack.
Researchers at McMaster University in Hamilton, Ontario, compared the safety and efficacy of varying doses of aspirin -- low (less than 100 mg); intermediate (101 to 199 mg); and high (more than 200 mg) -- in 2,658 patients with ACS undergoing percutaneous coronary intervention (PCI). PCI involves procedures such as angioplasty with or without the placement of artery-opening stents.
At 30 days and eight months after the procedure, all the patients had similar rates of cardiovascular death, heart attack and stroke. While rates of major bleeding were similar among all groups after 30 days, the rate of major bleeding in the low-dose aspirin group was noticeably reduced after eight months.
"In this large observational analysis, low-dose ASA (aspirin) appeared to be just as effective as high-dose ASA in preventing recurrent cardiac events in ACS patients after PCI, while reducing the long-term risk of major bleeding," lead author Sanjit Jolly said in a prepared statement.
"These data are intriguing, since low-dose aspirin is most commonly prescribed in Europe, but, in the United States, higher doses are most commonly used. Our data suggest that lower doses may be safer, but this finding needs confirmation in a dedicated randomized trial," principal investigator Dr. Shamir R. Mehta, associate professor of medicine, said in a prepared statement.