Aspirin risks and benefits among older people

Low Dose or No Dose

Television advertisements that pitch aspirin to prevent heart attacks would have you believe that low dosages of the 20th Century wonder drug are as sweetly benign as drinking water from a high mountain stream.

HSI members know that this representation of aspirin is off the mark. And now new research implies that elderly people who are taking aspirin to help prevent heart attacks and stroke may be setting the stage for serious health problems.

Super model

Researchers at the University of Tasmania School of Medicine (UT) in Australia designed an epidemiological model to assess aspirin risks and benefits among older people.

What’s an epidemiological model? It’s a method of combining clinical trial data with observational evidence to create hypothetical populations. In this case, the UT team established reference populations of 10,000 men and 10,000 women who used low-dose aspirin therapy, were aged 70-74, and had no history of cardiovascular disease.

Researchers measured the results by looking for first-time heart attacks, stroke and major hemorrhage in the gastrointestinal (GI) tract. As reported in an online edition of the British Medical Journal, the model showed that while heart attacks and ischaemic strokes may have been prevented, this benefit was offset by a significant number of subjects with sharply increased risk of bleeding in the brain and/or GI tract.

In a BBC News account of the study the medical director of the British Heart Foundation, Professor Peter Weissberg, noted that given the UT study results, a clinical trial to test effects of low-dose aspirin therapy in older people “should be undertaken before aspirin is advocated for primary prevention of heart disease in the elderly community.”

Stop! Don’t stop!

So, if you’re over the age of 70 and you’re currently taking aspirin to help prevent a heart attack or stroke, should you discontinue the daily dose?

In a word: No.

In three words: Call your doctor.

Here’s why: A 2003 study demonstrated how severe angina and fatal heart attacks might be prompted by the sudden halt of daily aspirin intake.

In reviewing more than 1,200 cases of coronary episodes, French researchers found 51 patients who suffered heart attacks or other severe coronary problems less than one week after they stopped using aspirin. Subjects with a history of heart disease were at particularly high risk. The French team told Reuters news service that doctors should not advise their coronary patients to stop using aspirin, and even stated that aspirin therapy “cannot be safely stopped in any case.”

How’s that for a “wonder drug”! You begin an aspirin regimen to protect your heart, but if you stop, you stand a chance of prompting a dangerous coronary episode. So if you’re taking a daily aspirin and you’re over the age of 70, share these study results with your doctor to assess your personal risk/benefit ratio.

Hungry for prevention

Ironically, many people who are taking a daily aspirin to help their heart may already be getting plenty of heart attack protection from the foods they eat.

In the e-Alert “Pain Takes a Holiday” (9/8/03) I told you about a 15-month study of almost 2,000 subjects that showed how those whose diets included the highest fruit intake had more than 70 percent reduced risk of heart attack and other cardiac problems compared with those who ate the least amount of fruit. On average, for every additional piece of fruit consumed each day, subjects showed a 10 percent reduction in coronary risk.

And vegetable intake produced a similar effect. Subjects who consumed vegetables three or more times each week had approximately 70 percent lower heart attack risk than those who ate no vegetables at all.

These heart protective benefits are most likely due to flavonoids, the substance that gives fruits and vegetables their color. Flavonoids have both antioxidant and anti-inflammatory qualities; two benefits that are believed to help curb chronic diseases, including heart disease, lung cancer, stroke, asthma, and type 2 diabetes.

To Your Good Health,

Jenny Thompson
Health Sciences Institute

Sources:

“Epidemiological Modelling of Routine Use of Low Dose Aspirin for the Primary Prevention of Coronary Heart Disease and Stroke in Those Aged 70 or Greater” British Medical Journal, published online 5/20/05, bmj.bmjjournals.com

“Aspirin for Over 70s in Question” BBC News, 5/19/05, news.bbc.co.uk

“Halting Aspirin Suddenly can Cause Heart Attack” Reuters, 10/29/03, reuters.com

“Waist Size Linked to Diabetes Risk in Adult Men” Johns Hopkins University Bloomberg School of Public Health press release, 3/17/05, eurekalert.org