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Daily aspirin doesn’t prevent strokes in older, healthy people after all

<a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The daily use of <a href="https://www.nps.org.au/australian-prescriber/articles/drugs-in-secondary-stroke-prevention">low dose aspirin</a> has been a mainstay of preventing strokes for decades. While there has always been a risk of bleeding associated with aspirin use, the benefits were thought to outweigh the risk. Now <a href="https://dx.doi.org/10.1001/jamanetworkopen.2023.25803">new research</a> led by Monash University has shown daily, low-dose aspirin doesn’t prevent strokes in relatively healthy people aged over 70. And it increases their risk of bleeding on the brain after falls or other injuries. But if you’re taking aspirin, it doesn’t mean you should abruptly stop. It may still have a role to play in treating people at high risk of stroke. Or, after talking to your doctor, there might be better options available. <h2>Why has aspirin been used to prevent strokes?</h2> Aspirin is an anti-platelet medicine, which is commonly known as a blood-thinner. <a href="https://www.lifeblood.com.au/blood/learn-about-blood/platelets">Platelets</a> are the component of blood primarily responsible for its clotting action. They are what stop you from continuously bleeding any time you have a cut or scrape on your skin. A <a href="https://strokefoundation.org.au/about-stroke/learn/what-is-a-stroke">stroke</a> is when oxygen can’t get into the brain because of a burst or blocked blood vessel. A blockage can occur when platelets in the bloodstream form a clot and it gets stuck in the artery. Because aspirin acts on platelets, it can help prevent the clots that can lead to a stroke. But because aspirin acts on platelets, it can also increase the risk of <a href="https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797#:%7E:text=While%20daily%20aspirin%20can%20help,of%20developing%20a%20stomach%20ulcer.">unwanted bleeding</a>, usually in the stomach. It can also increase your risk of bleeding more when you have another injury, like hitting your head. Aspirin isn’t just used for the prevention of strokes. It is also the first aid treatment for someone undergoing a <a href="https://www.nps.org.au/australian-prescriber/articles/acute-myocardial-infarction-early-treatment">heart attack</a>. <h2>Findings of the Monash trial</h2> New <a href="https://dx.doi.org/10.1001/jamanetworkopen.2023.25803">research from Australia and the United States</a> reports results from the Aspirin in Reducing Events in the Elderly (ASPREE) trial. The researchers examined the protective use of daily low-dose aspirin (100 mg) in nearly 2,000 people who were aged 70 years and older and had no history of heart disease or stroke and whose blood pressure and cholesterol were well managed. When compared with placebo, aspirin didn’t reduce or increase the risk of stroke. Of the participants who took the aspirin, 195 or 4.6% had a stroke. Of those who took the placebo, 203 people or 4.7% had a stroke. But it did statistically increase the rate of non-stroke bleeding in the participants’ brains, for example when they injured their head. Those on aspirin showed a rate of bleeding in the brain of 1.1% (108 participants) compared with 0.8% (79 people) for those on placebo. This is a relatively, low but serious, risk. These findings are not entirely new. <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1800722?query=featured_home">Research</a> published five years ago based on the same ASPREE trial showed a similar result: a higher rate of bleeding among those taking low-dose aspirin compared with placebo. However as the study authors note, aspirin continues to be widely used for the prevention of stroke. <h2>What are the study’s limitations?</h2> The researchers examined aspirin in mostly people of white European heritage. So we don’t know whether the results are translatable to people with different ethnic backgrounds. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594139/">Genetics and ethnicity</a> can significantly impact the efficacy and safety of some drugs. The clinical trial only included people who were not significantly at risk of a stroke, and had no history of heart disease. Younger age groups were not studied either, so we cannot make any conclusions about their use of low dose aspirin to prevent stroke. It’s also possible the potential benefits and risks are different for those who have underlying heart problems or who have previously had a stroke and are therefore at higher risk of another stroke. <h2>I’m taking aspirin, what should I do?</h2> If you’re taking daily low-dose aspirin and are concerned by the results of the study, it’s important you don’t just stop taking your medicine. Speak to your doctor or pharmacist. For people who are at high risk of having a stroke, or have previously had one, low-dose aspirin may remain their treatment of choice despite the slight bleeding risk. If you’re at high risk of bleeding, for example because of falls and other accidents due to advanced age, frailty, or another underlying condition, your doctor may be able to reduce the amount of aspirin you take by adding in <a href="https://www.nps.org.au/australian-prescriber/articles/dipyridamole">dipyridamole</a> or prescribing a different medicine completely, such as <a href="https://www.nps.org.au/australian-prescriber/articles/clopidogrel">clopidogrel</a>.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/210388/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/daily-aspirin-doesnt-prevent-strokes-in-older-healthy-people-after-all-210388">original article</a>.

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Aspirin could be our next weapon against aggressive breast cancer

Aspirin may be used in future treatments of breast cancer, with doctors saying it can make hard-to-treat tumours more responsive to anti-cancer drugs. A new trial is starting in Manchester, England, with triple-negative breast-cancer patients, run by a team at the Christie NHS Foundation Trust. The team suspects aspirin’s anti-inflammatory properties may be what boost the effectiveness of anti-cancer drugs, rather than its analgesic effect. Though animal studies have shown encouraging results and there is some evidence aspirin may help prevent other cancers, more research is needed before it is recommended as a treatment. Around 15 percent of breast cancers are triple negative, which is a more aggressive type of breast cancer and frequently affects younger women and black women. Triple negative cancer tumours lack some of the receptors that other breast cancers have, which means they can’t be treated with drugs such as herceptin. But other treatments could work. In the Manchester trial, some patients will be given aspirin and immunotherapy drug avelumab before they undergo surgery and chemotherapy. If the trial is successful, further clinical trials could start to test the effectiveness of aspirin and avelumab on incurable secondary triple-negative breast cancer - the stage where cancer cells start to spread to other parts of the body. “Not all breast cancers respond well to immunotherapy,” trial lead Dr Anne Armstrong said. “Trialling the use of a drug like aspirin is exciting because it is so widely available and inexpensive to produce. “We hope our trial will show that, when combined with immunotherapy, aspirin can enhance its effects and may ultimately provide a safe new way to treat breast cancer.” Co-researcher Dr Rebecca Lee said their findings suggest that aspirin may be preventing the cancer from making substances that weaken the body’s immune response, in turn increasing the effectiveness of certain types of immunotherapy. “We hope aspirin can dampen down bad inflammation so the immune system can get on with the job of killing cancer cells,” she said.

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Need pain relief? Grab a beer instead of an aspirin

A recent <a href="http://www.jpain.org/article/S1526-5900%2816%2930334-0/fulltext">study</a> from The Journal of Pain found that drinking beer, besides giving you a pleasant buzz, can actually make you feel less physical pain. Study author Trevor Thompson, PhD, told <a href="https://www.thesun.co.uk/living/3440973/two-pints-of-beer-are-better-than-paracetamol-for-beating-pain-and-cut-agony-by-a-quarter-doctors-claim/">The Sun</a> that alcohol could even be “compared to opioid drugs such as codeine,” and that “the effect is more powerful than paracetamol” (comparable to Tylenol). According to their findings, drinking two beers is more effective at relieving pain than taking painkillers. For their research, the scientists—from London’s Greenwich University, conducted a total of 18 experiments in which 404 participants were given either an alcoholic or non-alcoholic beverage. Next the team administered 13 pain-threshold tests as well as 9 pain intensity ratings. What they found was that alcohol had a significant analgesic effect, meaning it greatly reduced pain. The tipping point was a legal driving blood alcohol content (BAC) limit of .08. Although the effect was clear, the research team couldn’t determine whether the pain relief came from an effect on pain receptors or just maybe a lowering of anxiety, which could lower perception of pain. Regardless of exactly how beer works to ease pain, the researchers did note that people who suffer from chronic pain tend to drink more due to the pain-dulling effect. While a few drinks a day could dull your pain, the study caution that there are numerous unhealthy effects that may not make beer your go-to analgesic (in short: keeping your drinking in check is the way to go). And as with any study, more research is likely needed to confirm the results. Written by Chhaya Nene. This article first appeared in <a href="http://www.readersdigest.com.au/healthsmart/conditions/flu/need-pain-relief-grab-beer-instead-aspirin">Reader’s Digest.</a> For more of what you love from the world’s best-loved magazine, <a href="http://readersdigest.innovations.co.nz/c/readersdigestemailsubscribe?utm_source=over60&utm_medium=articles&utm_campaign=RDSUB&keycode=WRN93V">Here’s our subscription offer.</a> <img style="width: 100px !important; height: 100px !important;" src="https://oversixtydev.blob.core.windows.net/media/7820640/1.png" alt="" data-udi="umb://media/f30947086c8e47b89cb076eb5bb9b3e2" />

Caring

This common painkiller causes 3,000 deaths a year in the UK

Taking a daily aspirin is far more dangerous than was originally thought and causes more than 3,000 deaths a year in Britain, a major study suggests. Millions of pensioners take the blood-thinning pills to ward off heart attacks and strokes. But researchers at Oxford University found that those older than 75 who use aspirin daily are 10 times more likely than younger patients to suffer disabling or fatal bleeds. Researchers said patients of this age who have already suffered heart attacks or stroke should still take the daily tablet, but should also take an extra drug to reduce the risk of bleeding. The study says pensioners who take aspirin daily "as a health choice" should consider weaning themselves off of the drug. However, doctors stressed that no-one should come off the pills quickly, or without consulting their GP, as doing so would create an immediate risk of heart attack. It has long been known that aspirin carries an increased risk of gastro-intestinal bleeding but the new study, published in The Lancet, suggests the danger rises far more sharply with age than was thought. The study's lead author, Prof Peter Rothwell, said blood thinners were causing around 20,000 bleeds annually, of which at least 3,000 were fatal. All patients who have had a heart attack or stroke should still take aspirin, he stressed. But those above the age of 75 should also be prescribed a proton pump inhibitor which would reduce bleeding risks by up to 90 per cent. Those without such medical histories should consider coming off aspirin altogether, he suggested. A New Zealand doctor said clinicians needed to consider many factors when discussing aspirin use with older patients. "Guidelines should be very carefully interpreted in older populations – since there is so much diversity, [from] relatively healthy people who can even climb Mt Everest to very frail people on many medicines," said Otago University professor of public health Nick Wilson. "So this is why a clinician needs to consider many issues and discuss these with the individual older patient – and be ready to review if any problems develop." The UK study involved 3,166 patients who had a stroke or heart attack, most of whom were prescribed aspirin. For patients under 65, the annual rate of disabling or fatal bleeding was less than 0.5 per cent, rising to 1.5 per cent in those aged 75 to 84 and nearly 2.5 per cent for patients aged 85 or older. Over the decade, those over 75 had six times the risk of fatal bleeds, and a tenfold increased risk of bleeds which were either deadly or disabling. The proportion of survivors experiencing a new or worse disability rose from three per cent for those under 75 to 25 per cent among older patients. Those without a history of heart attack or stroke should avoid taking aspirin as they got older, said Prof Rothwell. While the drugs had "tiny benefits" for such patients in their 50s and 60s, the dangers increase with age. "You would probably be advised to stop it in your late 60s or around 70 because at that point the risks may well outweigh the benefits," he said. Doctors stressed no-one should come off their drugs quickly or without consulting a GP. But Dr Tim Chico, consultant cardiologist at the University of Sheffield, said the risks of aspirin were often underestimated. "Although bleeding is a well-recognised side effect, this drug is still seen by many people as harmless, perhaps because of how easily it can be bought," he said. Written by Laura Donnelly. First appeared on <a href="http://Stuff.co.nz" target="_blank">Stuff.co.nz</a>.

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Daily aspirin doesn’t prevent strokes in older, healthy people after all

Aspirin could be our next weapon against aggressive breast cancer

Need pain relief? Grab a beer instead of an aspirin

This common painkiller causes 3,000 deaths a year in the UK