Study details

For the study, researchers used data from the Aspirin in Reducing Events in the Elderly study — a randomized control trial of daily low-dose aspirin among people living Australia and the United States. In total there were 19,114 participants, all adults over the age of 70 and free of any symptomatic cardiovascular disease.

In the study, researchers randomly assigned 9,525 people to take 100 milligrams of aspirin a day and 9,589 people to take placebo pills, and then followed the participants for a median of 4.7 years.

The researchers found that aspirin appeared to reduce the occurrence of ischemic stroke, but not in a significant way. They also found a notable 38% increase of intracranial bleeding among people who took the daily aspirin compared to those who took a placebo.

Discussion

Experts praised the study's size and design — in which specialists reviewed medical records rather than relying on self-reported outcomes from patients — but noted that stroke rates were low in both groups, which make the results difficult to extrapolate. They also noted that 91% of the participants in the study were white, raising questions as to how the findings would apply to a more diverse population.

"We can be very emphatic that healthy people who are not on aspirin and do not have multiple risk factors should not be starting it now," said Randall Stafford, a medical professor and epidemiologist at Stanford University.

Stafford acknowledged the decision wasn't as clear for people not fitting that description. "The longer you've been on aspirin and the more risk factors you have for heart attacks and strokes, the murkier it gets," he said.

Last year, the U.S. Preventive Services Task Force recommended that most people who had never had a heart attack or stroke refrain from taking low-dose aspiring because of internal bleeding risk. After that, the American College of Cardiology noted that the recommendation "does not apply to patients with a prior history of heart attack, stroke, bypass surgery, or recent stent procedure."

Regardless, experts said no one should stop taking aspiring without first consulting a doctor.

"When a study comes out, you have to ask yourself, how well do I fit in this study's population?" said Shlee Song, director of the Comprehensive Stroke and Telestroke Programs at Cedars-Sinai Medical Center. "If you've ever had a heart attack or stroke event, this study's findings do not apply to you."

Song has previously urged patients not to stop taking daily aspirin and said that the new study hasn't changed her opinion.

"There is a lot of noise out there," she said. "At the end of the day, these things will need to be discussed with a doctor who knows your specific story."

Joshua Wiley, an associated professor of neurology and a stroke specialist at the Columbia University Vagelos College of Physicians and Surgeons, said the potential risks and benefits would differ for each patients, depending on how long they've been taking aspirin and why the drug was recommended to them in the first place. But for another patient at high risk of a different condition, like colorectal cancer, a doctor might determine aspirin offers protective power that offsets a patient's risk of bleeding.

For patients who need to stay on aspirin, Wiley said the study's findings have a different significance for providers. "Check their balance, get them physical therapy, make sure the house is set up properly. Do everything you can in that Medicare age group to mitigate the risk of a fall," he said. (Baumgaertner, New York Times, 7/26)

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