The Case for Low Dose Aspirin is Dead

I’m a researcher, not a doctor. With that caveat in mind, over the last four weeks, we have received reports of three different studies involving upwards of 30,000 patients, that destroy the case for using aspirin to reduce heart risks.

  • The ASCEND trial, which looked at aspirin for primary prevention in 15,000 patients with diabetes
  • ARRIVE, a randomized trial of 13,000 patients with moderate cardiovascular risk
  • ASPREE, a study involving more than 20,000 patients over the age of 70 in the US and Australia

The findings are summarized in an important Medscape article by F. Perry Wilson of the Yale School of Medicine.(1) The basic points are:

  • Aspirin doesn’t reduce coronary risks. In controlled experiments, there is no evidence that it helps.
  • Aspirin can cause bleeding events especially in the elderly that can be serious, even potentially life threatening.

The ASPREE trial showed that aspirin did not prevent disability-free survival, but did increase major bleeding compared with placebo.(4)

The ASCEND Aspirin trial showed that the absolute reduction in cardiovascular events from aspirin was offset by a similar absolute increase in major bleeding.(8)

Wilson’s interpretation is that due to other methods for dealing with coronary risk, there is no longer a role for aspirin. He doesn’t give credence to the finding that a daily dose of aspirin could be harmful, although that is in the data.

Basically, if you are on an aspirin regimen due to advertising you’ve seen, you probably should stop and/or consult your doctor. If you doctor has recommended an aspirin regimen, you need to discuss these findings with him or her and determine whether you should still be taking it. This is new, so you doc may not have seen these results.


Sources:

  1. https://www.medscape.com/viewarticle/901966?nlid=125148_381&src=WNL_mdplsnews_180921_mscpedit_wir&uac=153634BV&spon=17&impID=1745938&faf=1#vp_2
  2. https://clinicaltrials.gov/ct2/show/NCT01038583
  3. http://aspree.org/     This is a website for this clinical trial
  4. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/09/16/21/55/aspree  This is the summary from the American College of Cardiology
  5. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/fulltext
  6. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/08/25/01/46/arrive
  7. https://www.medscape.com/viewarticle/901208
  8. https://www.acc.org/latest-in-cardiology/clinical-trials/2018/08/25/02/16/ascend-aspirin

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