Daily baby aspirin increases the risk of brain bleeds without reducing the risk of stroke.

Daily baby aspirin increases the risk of brain bleeds without reducing the risk of stroke.

Baby Aspirin May Not Be Worth the Risk, Study Says

Photo by Amy Norton

For years, older adults took a baby aspirin a day to help ward off a first-time heart attack or stroke. But now, a recent study suggests that the risks may not be worth it for most of them. The study found that the risk of brain bleeding while using low-dose aspirin outweighed any potential benefit against stroke for relatively healthy older adults who have no history of heart disease or stroke.

According to the findings of the study, which included over 19,000 older adults, those who took daily low-dose aspirin for several years showed no reduction in their risk of an ischemic stroke (the kind caused by a blood clot). However, they did have a 38% higher risk of bleeding in the brain compared to those who were given placebo pills for comparison.

Dr. Anum Saeed, a cardiologist who was not involved in the study, commented that the findings align with the latest recommendations on low-dose aspirin. Most people with no history of cardiovascular disease, including heart attack or stroke, should skip it.

The study’s findings are not applicable to people who have already been prescribed aspirin due to their preexisting conditions. However, Dr. Mitchell Elkind, chief clinical science officer for the American Heart Association (AHA), stated that the findings support what is recommended for younger people as well. He mentioned that the current guidelines from professional societies, including the AHA, advise against taking aspirin for primary prevention for most individuals of any age.

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Taking a baby aspirin a day was previously recommended for middle-aged and older adults to lower the risk of a blood clot forming and potentially triggering a heart attack or stroke. However, within the past few years, medical groups like the American College of Cardiology (ACC) and the AHA have changed their recommendations based on new evidence. These changes were due to the fact that people now have better control over their blood pressure and diabetes, and are smoking less, compared to a few decades ago. Additionally, many are taking statins, which further reduce the risk of heart attack and stroke. These factors have led to the decreased need for aspirin, as the benefits no longer outweigh the potential risks.

The new findings, published in JAMA Network Open, were based on an analysis of a previously reported clinical trial that included more than 19,000 adults aged 65 and older. The trial participants were randomly assigned to either take low-dose aspirin or receive a placebo. Over the next four to five years of the study, aspirin users were found to be more likely to suffer from brain bleeding, with a rate of just over 1% compared to 0.8% in the placebo group. However, there was no corresponding benefit in terms of a reduction in the rates of ischemic stroke.

Although the general recommendation is for most individuals to skip aspirin for primary prevention, there may be some exceptions. Dr. Elkind stated that if a person between the ages of 40 and 70 is considered to be at high risk for a heart attack or stroke and at low risk of bleeding, aspirin might be considered. Factors such as a strong family history or a high score on coronary calcium testing, indicating the presence of arterial plaques, could contribute to this decision. However, it is crucial to remember that aspirin should not be considered routine or low-risk, and patients should be evaluated individually based on their specific constellation of risk factors and bleeding tendency.

For people who are already on low-dose aspirin, Dr. Anum Saeed emphasizes the importance of not stopping the medication without consulting a healthcare professional. It is essential to have a discussion with a doctor to understand why aspirin has been prescribed and whether it should be continued.

The study was led by Geoffrey Cloud, a professor of neuroscience at Monash University in Melbourne, Australia, and Dr. Jeff Williamson of Wake Forest School of Medicine in Winston-Salem, N.C.

For more information, please visit the American Heart Association website.

Sources:

1. Amy Norton, HealthDay Reporter
2. Anum Saeed, MD, Assistant Professor of Medicine, University of Pittsburgh Medical Center, and member of the Prevention Council, American College of Cardiology, Washington, D.C.
3. Mitchell Elkind, MD, MS, Chief Clinical Science Officer, American Heart Association, and Professor of Neurology and Epidemiology, Columbia University Irving Medical Center, New York City
4. JAMA Network Open, July 26, 2023, online.