The three reports originated with the ASPREE trial of 19,000 Australians and Americans age 70 years or older, randomized to aspirin 100 mg per day vs. placebo: no difference in cardiovascular death or cardiovascular events (fatal heart attack, non-fatal heart attack, stroke) over nearly 5 years, with about a 1.5% increase in bleeding (e.g., intracranial bleeding, gastrointestinal haemorrhage).
Previous clinical trials (prospective, randomized to aspirin vs. placebo) in broader populations examining whether low-dose aspirin (typically 81-100 mg, a baby aspirin) likewise mostly suggest no benefit, much in line with these recent reports in people 70 years or older. The recent ARRIVE trial of 12,000 participants, for instance, randomized to aspirin 100 mg vs. placebo, showed no benefit and a modest increase in bleeding from aspirin.
People who are hypercoagulable, i.e., have more platelet activation, higher levels of the blood clotting protein fibrinogen, have greater inflammation and insulin resistance, do indeed appear to gain a teensy-weensy benefit by taking low-dose aspirin, as shown in the recent ASCEND Study of 15,000 people with type 2 diabetes (i.e., people we know are inflamed, insulin resistant, nearly all overweight or obese, have greater platelet activation and fibrinogen levels) randomized to aspirin 100 mg per day or placebo: about a 1% reduction in cardiovascular events over 7 1/2 years (i.e., 0.13% reduction per year) and 1% increase in bleeding—hardly headline-worthy.
Let’s step back for a moment and take a look at the broader landscape. National dietary guidelines advocate limiting total and saturated fat, increased consumption of whole grains, and sugar in moderation, a lifestyle that has been associated with a dramatic surge in weight gain/overweight/obesity, epidemic levels of type 2 diabetes and pre-diabetes, autoimmune inflammation, hypercoagulability, and other “diseases of lifestyle.” In other words, dietary guidelines have created a population-wide hypercoagulable state with the most hypercoagulable obtaining about 1/10th of one percent per year reduction in cardiovascular events on aspirin and about the same risk of haemorrhage into the brain or gastrointestinal tract.
These most recent reports involving treatment randomization, large numbers of participants, with extended follow-up periods also counter a handful of previous observations suggesting a very small reduction in colorectal cancer on low-dose aspirin. ASPREE suggested about a 1% increase in cancer deaths (though no difference in cancer incidence).
Is aspirin a miracle drug for preventing cardiovascular events? Hardly. A 1/10th of one percent per year reduction in cardiovascular events in higher-risk hypercoagulable people at the cost of serious haemorrhage, sometimes fatal, is, in my mind, no benefit at all. And, putting all the evidence on cancer incidence together, it looks like aspirin likewise has little to no benefit in reducing colon cancer risk.
So much time and effort has been devoted to exploring a drug that yields so little in the way of preventive effects in the broad population. My advice: Eat healthy" ...
Words and picture above, plus all relevant links can be found at link below
Please note that, Dr. Davis the writer of the article above says 'nothing here should be construed as medical advice, but only topics for further discussion with your doctor'
All the best Jan