US study finds millions take daily aspirin unnecessarily

Matt Woodley

26/07/2019 1:49:17 PM

But is the potentially dangerous phenomenon as common in Australia?

Elderly woman taking aspirin
Daily aspirin use is not recommend for primary prevention of cardiovascular disease in people over the age of 70.

The research, based on the 2017 National Health Interview Survey, estimates that approximately 29 million people aged 40 and above take aspirin daily even though they don’t have a known heart disease.
It’s thought around 6.6 million do so without a recommendation from their doctor. Another 10 million people over the age of 70 without any current heart disease problems also take aspirin every day, in spite of the latest guidelines specifically advising against such an intake.
Chair of General Practice at the University of Tasmania Professor Mark Nelson, a principal investigator on the ‘Aspirin in reducing events in the elderly’ (ASPREE) study, told newsGP the main problem highlighted in the study is not overuse, but inappropriate use.
However, he does not believe inappropriate use is as pronounced in Australia.
‘Use of aspirin in the over 70s was much less so for Australians – 11% of the cohort in ASPREE were previous regular aspirin users, where use in the US was about four times greater than in Australia,’ he said.
‘Aspirin use was more common the older the individuals were, as was found in the US study.’
Despite low-dose aspirin remaining as a Level 1 evidenced agent for secondary prevention of cardiovascular disease, Professor Nelson believes more should be done to spread the message about where and when it’s appropriate to use.
‘The US guidelines no longer recommend the use of aspirin for primary prevention over the age of 70,’ he said.
‘[In particular], there needs to be public education as this is an over-the-counter medication.’
Fellow GP researcher and chief investigator of the ASPREE trial in South Australia, Professor Nigel Stocks, told newsGP aspirin should only be used infrequently in the routine primary prevention of atherosclerotic cardiovascular disease (ASCVD) because of a lack of net benefit.
He pointed to US guidelines that recommend low-dose aspirin (75–100 mg orally daily) be considered for the primary prevention of ASCVD among select adults aged 40–70 years at higher ASCVD risk, but not at increased bleeding risk. The same guidelines indicate low-dose aspirin not be administered on a routine basis for the primary prevention of ASCVD among adults over 70 years of age, or among adults of any age who are at increased of bleeding.
‘I think this is reasonable advice,’ he said.
Clinical practice guidelines for the prevention, early detection and management of colorectal cancer also recommend active consideration of daily low-dose aspirin for at least two-and-a-half years for all people aged 50–70 years who are at average risk of colorectal cancer.
However, it also states the choice to take aspirin should be personalised based on age, sex and potential reduction in cardiovascular events, cerebrovascular events and thrombotic stroke, as well as the potential risks of taking aspirin – a point Professor Stocks supports.
‘I am cautious about recommending aspirin use for the prevention of colorectal cancer in people at average risk because of the potential harms,’ he said. 
‘[Especially as] in Australia we have a good screening program, albeit with an uptake that could be improved – perhaps by increasing the involvement of general practice.’
The guidelines state aspirin should be avoided in patients with current dyspepsia, any history of peptic ulcer, aspirin allergy, bleeding diathesis, an increased risk of gastrointestinal haemorrhage (such as associated with use of oral anticoagulants or antiplatelet agents), or renal impairment.
A study of 164,000 people without existing heart disease conditions released earlier this year, showed a 0.38% lower absolute risk of heart attacks, strokes, or death from cardiovascular events based on daily aspirin intake. However, the data also showed a 0.47% higher absolute risk of severe internal bleeding.

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