and Medicine for Seniors
seniors take a daily aspirin if they need it or not
Why do so many older adults gobble
down aspirin when it is not recommended by FDA?
16, 2015 - More than half of older Americans – those age 45 through 75 –
take an aspirin every day, even though this use is not recommended by
the Food and Drug Administration for most people who have not yet had a
heart attack or stroke.
Aspirin use is continuing to surge,
especially among adults who are using it for "primary prevention,"
meaning in order to prevent an initial cardiovascular event, and in some
cases to prevent cancer, according to an analysis of a national survey
was published today in the American Journal of Preventive Medicine.
In this survey of more than 2,500
respondents aged 45-75, 52 percent reported current aspirin use, and
another 21 percent had used it at some point in the past. The average
age of respondents in the survey was 60. A different report found that
aspirin use increased 57 percent between 2005 and 2010.
Aspirin is a blood thinner and can
cause bleeding events, which is a primary reason some medical experts
recommend caution in its use, even at the "baby aspirin" dose of 81
milligrams often used for disease prevention. The FDA has determined
that in primary use to prevent a first heart attack or stroke, for every
such event that's prevented, there's approximately one major bleeding
event that's caused, such as gastrointestinal bleeding.
Largely on that basis, they have
concluded physicians should routinely recommend its use only to patients
that have already had a heart attack or stroke. But this study found
that 81 percent of older adults who are now using aspirin have not had a
heart attack or stroke, and are taking it for primary prevention.
"The use of aspirin is still a very
contentious issue among medical experts," said Craig Williams, a
pharmacotherapy specialist with the College of Pharmacy at Oregon State
University, and lead author of the new report.
"There's no doubt that aspirin use
can have value for people who have experienced a first heart attack,
stroke or angina," said Williams, a professor in the Oregon State
University/Oregon Health & Science University College of Pharmacy. "The
data to support that is very strong. The support of its use in primary
prevention is more of a mixed bag.
"But this survey clearly shows that
more and more people who have not experienced those events and are not
technically considered at high risk by the FDA are also deciding to use
aspirin, usually in consultation with their doctors."
Aside from cardiovascular events,
some studies have suggested a role for aspirin in preventing cancer,
Williams said, especially colon cancer. That has further increased
interest in its use, he said.
While the FDA takes a more cautious
stance, Williams said, some other professional organizations, such as
the U.S. Preventative Services Task Force, says aspirin use may be
appropriate for primary prevention in people with serious risk factors
for cardiovascular disease, such as high blood pressure, high
cholesterol, smoking or diabetes. Objective criteria for aspirin use in
those patients are based on the number of the risk factors, the age and
gender of the patient.
Surveys such as this are needed to
help determine how people are managing their own health, Williams said,
since aspirin is an over-the-counter medication and its use cannot be
determined solely by medical records. And the findings suggest that tens
of millions of Americans have reviewed the issues involved, often
discussed it with their doctors, say they know what they are doing - and
decided to use aspirin.
Among the findings of the
● Several markers of healthy
lifestyle choices were also associated with aspirin use.
● The strongest predictor of
regular aspirin use was a patient having discussed aspirin therapy with
a health care provider.
● About 35 percent of people who
don't objectively have risk factors that might merit aspirin therapy
still use it.
● About 20 percent of people who
have already had a heart attack or stroke, and should be on aspirin
therapy, do not use it.
● A majority of both current and
previous aspirin users rated themselves as being somewhat or very
knowledgeable about it.
● Among aspirin users, the
reasons cited for its use by respondents was for heart attack
prevention, 84 percent; stroke prevention, 66 percent; cancer
prevention, 18 percent; and prevention of Alzheimer's disease, 11
● Significant predictors of
aspirin use included people who were physically active, ate healthy
foods, had achieved a healthy weight, managed their stress, tried to
quit smoking, and/or had undergone health screenings.
This study was sponsored by the
Partnership for Prevention and the Council on Aspirin for Health and
Prevention. This council receives financial support from Bayer
HealthCare, which has no influence over its programs or activities, and
played no role in the decision to conduct this research or publish the
Collaborators with Oregon State
University on the research were from Harvard/Brigham and Women's
Hospital; the Partnership for Prevention; The Ohio State University; the
University of North Carolina; and Stanford University.