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Evidence Summary

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Aspirin for healthy older adults did not reduce heart attack, stroke, or dementia but increased risk of bleeding

McNeil JJ, Wolfe R, Woods RL, et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med. 2018;379:1509-18.

McNeil JJ, Wolfe R, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379:1499-1508.

McNeil JJ, Nelson NR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018;379:1519-28.

Review question

Does low-dose aspirin prevent heart attack, stroke, dementia, disability, or death in healthy older adults?

Background

Aspirin is often taken by people who have had a heart attack or stroke to prevent these events from happening again. For years, doctors have recommended that some older adults who have never had a heart attack or stroke take an aspirin each day to prevent these events. However, aspirin can cause bleeding, and it wasn’t clear if taking aspirin daily causes more harm than good in some people.

How the trial was done

The researchers did a randomized controlled trial of 19 114 healthy older adults who had no chronic illnesses or history of heart attack, stroke, or other heart conditions, and were living in the USA or Australia.

People in the study were either ≥ 70 years of age or ≥ 65 years of age if they were black or Hispanic and living in the USA.

Coated aspirin, 100 mg per day, for up to 6 years, was compared with placebo.

What the researchers found

Aspirin for preventing disease

Compared with placebo, aspirin did not prevent heart attack, stroke, or hospitalization for heart failure. It also did not reduce the chance of developing dementia or persistent physical disability.

Harms of aspirin

Compared with placebo, aspirin increased risk of major bleeding and death from any cause.

Conclusions

In healthy older adults, aspirin did not prevent heart attacks or strokes and did not improve survival without dementia or physical disability. People taking aspirin were a little more likely to have major bleeding or die than those not taking aspirin. It is important to recognize that these results do not apply to people who have a history of heart disease or stroke.

Aspirin vs placebo in healthy older adults

Outcomes

Rate of events with aspirin

Rate of events with placebo

Effect of aspirin

Cardiovascular disease*

4.7%

4.9%

No difference in effect†

Survival without dementia or physical disability

9.7%

9.5%

No difference in effect†

Dementia

3.0%

3.0%

No difference in effect

Persistent physical disability

2.0%

2.3%

No difference in effect†

Major bleeding

3.8%

2.8%

About 10 more people out of 1,000 had major bleeding

Death from any cause

5.9%

5.2%

About 7 more people out of 1,000 died

*This includes coronary heart disease, heart attack, stroke, or hospitalization for heart failure.

†Although the rates for the 2 groups look a little different, the differences were not statistically significant. This means that the differences could simply be due to chance rather than due to the different treatments.




Glossary

Coronary heart disease
Also known as coronary artery disease (CAD), is a narrowing of the blood vessels (coronary arteries) that supply oxygen and blood to the heart.
Placebo
A harmless, inactive, and simulated treatment.
Vascular
The body's network of blood vessels. It includes the arteries, veins, and capillaries that carry blood to and from the heart.

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