Sunday, 16 September 2018

Aspirin Late in Life? Healthy People May

Healthy People May Not Need It

Low-Dose Aspirin Late in Life? Healthy People May Not Need It

Should older people in healthiness start taking aspirin to stop heart attacks, strokes, dementia, and cancer?

No, consistent with a study of quite 19,000 people, including whites 70 and older, and blacks and Hispanics 65 and older.

They took low-dose aspirin — 100 milligrams — or a placebo a day for a median of 4.7 years. Aspirin did not help them — and may have done harm.

Taking it didn't lower their risks of disorder, dementia or disability.

And it increased the danger of serious bleeding within the alimentary canal, brain, or other sites that required transfusions or admission to the hospital.

The results were published on Sunday in three articles within the New England Journal of Medicine.

One disturbing result puzzled the researchers because it had not occurred in previous studies: a rather greater death rate among those that took aspirin, mostly due to an increase in cancer deaths — not new cancer cases, but death from the disease.

That finding needs more study before any conclusions are often drawn, the authors cautioned.

Scientists do not know what to make of it, particularly because earlier studies had suggested that aspirin could lower the danger of colorectal cancer.

The researchers had expected that aspirin would help prevent heart attacks and strokes in the study participants, therefore the results came as a surprise — “the ugly facts which slay a beautiful theory,” the leader of the study, Dr. John McNeil, of the department of epidemiology and medicine at Monash University in Melbourne, Australia said in a telephone interview.

The news can also come as a shock to many people that are dutifully swallowing their daily pills like a magic potion to ward off all manner of ills.

Although there is good evidence that aspirin can help people that have already had heart attacks or strokes, or who have a high risk that they're going to occur, the drug’s value is really not so clear for people with less risk, especially older ones.

The new report is the latest in a recent spate of clinical trials that have been trying to determine who really should take aspirin.

One study published in August found no benefit in low-risk patients.

Another found that aspirin could prevent cardiovascular events in people with diabetes, but that the benefits were outweighed by the risk of major bleeding.

A third study found that dose matters which heavier people might require more aspirin to prevent heart attacks, strokes, and cancer.

The newest findings apply only to people a bit like those within the study: within the same age ranges, and with no history of dementia, physical disability, heart attacks or strokes.

(Blacks and Hispanics were included in the study at a younger age than whites, because they have higher risks than do whites for dementia and disorder.)

In addition, most didn't take aspirin regularly before entering the study.

The message for the general public is those healthy older people shouldn't begin taking aspirin.

“If you don’t need it, don’t start it,” Dr. McNeil said.

But those that have already been using it regularly shouldn't quit supported these findings, he said, recommending that they ask their doctors first.

Dr. McNeil also emphasized that the new findings do not apply to people who have already had heart attacks or strokes, which usually involve blood clots.

Those patients need aspirin because it inhibits clotting.

The study, named Aspree, is vital because it addresses the unanswered question of whether healthy older people should take aspirin, said Dr. Dr. Evan Hadley, director of the division of geriatrics and gerontology at the National Institute on Aging, which helped pay for the research.

The National Cancer Institute, Monash University and The Australian government also paid. Bayer provided aspirin and placebos but had no other role.

“For healthy older people, there’s still an honest reason to speak to their doctors about what these findings mean for them individually,” Dr. Hadley said.

“This is the average for a large group. A doctor can help map out how it applies individually.

It’s especially important for people already taking aspirin who are over 70.

The study didn’t include many people who had been taking it and doesn’t address the question of continuous versus stopping.”

The most widely used guidelines for using aspirin to stop the disease came calling in 2016 from experts at us Preventive Services Task Force.

They recommend the drug to stop disorder and colorectal cancer in many of us aged 50 to 59 who have quite a ten percent risk of getting an attack or stroke during the next 10 years.

(That risk, supported age, vital sign, cholesterol et al.

Factors can be estimated with a web calculator from the American Heart Association and therefore the
American College of Cardiology.)

For people 60 to 69 with an equivalent risk level, the rules say it should be a private decision about whether to take aspirin.

But for people 70 and over, the rules say there’s not enough evidence to form any recommendation.
Asprey was designed to fill the knowledge gap for older people.

Rather than looking only at individual ailments, the study also tried to gauge aspirin’s effect on “disability-free survival,” meaning whether it could help older people prolong the time during which they continue to be healthy and independent.

“Preventive medicine is that specialize in older people, the way to keep them out of nursing homes, alive and healthy,” Dr. McNeil said.

”Why would an elderly person be taking a drug if it doesn’t keep them alive and healthy any longer? A lot of the previous studies have looked at aspirin and heart disease.

But tons of medicine benefit things and bad things. Just watching one doesn’t seem to be enough.”

The study enrolled 16,703 people from Australia, and 2,411 from us, starting in 2010.

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