Daily aspirin doesn't protect against heart attack or stroke in healthy older people
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What is the main topic discussed in this episode?
This is an ABC podcast.
Hello and welcome to this week's Health Report with me, Norman Swann. Today exploring some myths about home births. Not so bad after all for most women, but there's still a sting in the tail. If a mum hasn't been immunized for hooping cough, can you immunize a newborn to protect against this deadly infection for small babies? A new treatment for enlarged prostates that's showing promise and avoids the knife, and lodos aspirin. It's been estimated that around the world there are millions of people who are otherwise healthy, have never had a heart attack or stroke, are not at high risk of bowel cancer, yet who take aspirin on a daily basis, convinced that it's going to help. to help them. Well the evidence from the largest ever study in this area suggests not.
A huge trial called Asprey, involving healthy Australians and Americans aged over seventy, given lodos aspirin for five years, has found no benefits and some harms. The research was led by Professor John McNeil of the School of Public Health and Preventive Medicine at Monash University, who I spoke to before we went to air. Welcome to the health report, John. Thank you. No. Pretty impressive. Three papers in the New England Journal. What sparked this study? 'Cause it was Australian motivated even though it occurred in the United States as well.
I think we've been aware since the nineteen nineties that there's an evidence gap that many millions of people take aspirin every morning and the evidence base, particularly for those who haven't had a heart attack or a stroke or have no other medical reason to be taking it. The evidence just isn't there.
So what did you do in this study?
We recruited nineteen thousand one hundred people from the United States and Australia. Sixteen thousand seven hundred were from Australia and we followed them for an average of four point six years and half of them took aspirin and half of them took placebo.
And what were you looking for? What were your end points?
Well the end point here was disability free survival, which is a measure of how long elderly people stay healthy.
But how did you measure that?
By measuring how long it took for people to remain healthy without having a permanent physical disability or developing dementia.
And what did you find?
Why do millions of healthy older adults take low‑dose aspirin every day?
Well, we found three things. Firstly, low dose aspirin did not appear to increase survival.
Disability free survival or survival?
Disability free survival and survival. And it also didn't prevent heart attack or stroke. I think I should emphasise that this study was done in people who'd never had a heart attack or a stroke. Because people who have routinely take aspirin under very strong evidence to prevent them having another one.
So we're talking about healthy people recruited who are over seventy on average, is that right?
That's right. The average age is
seventy four. What about cancer? A lot of people take aspirin to prevent cancer and there is some randomized trial evidence that aspirin can prevent cancer.
Yes, this was a surprising finding in our study. There were numerically more people dying of cancer in the uh aspirin arm than in the placebo arm. This was a a relatively small effect. It wasn't statistically significant once we adjusted for the multiple comparisons that we were making. And it hasn't been seen in other large clinical trials.
What was the design of the large ASPREE trial on aspirin?
So we're suspending judgment as to what its significance really means. And what were the complications and the side effects? Well we had the usual side effect of bleeding. We took a lot of care over the measurement of bleeding because older people are more inclined to bleed. And aspirin enhances that effect and we certainly had an increase in hemorrhage in the people taking aspirin.
Now previous studies have suggested and we had the Sunday Health Report, I think it was last year, suggesting that if there was a hemorrhage risk it was early on and that settled down later.
We looked at this but we couldn't find that in according to our data, uh the risk of hemorrhage just kept going.
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Chapters
7 chapters
1
What is the main topic discussed in this episode?
0:02–2:07
2
Why do millions of healthy older adults take low‑dose aspirin every day?
2:07–3:10
3
What was the design of the large ASPREE trial on aspirin?
3:10–8:32
4
What were the primary outcomes measured in the ASPREE study?
8:32–10:03
5
Did low‑dose aspirin improve disability‑free survival in seniors?
10:03–11:04
6
Did aspirin reduce heart attacks, strokes, or cancer in the trial?
11:04–15:16
7
What bleeding and other side‑effects were observed with aspirin?
15:16–28:24
Speakers
2 identifiedMore from Health Report
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