Widespread aspirin use despite few benefits, high risks

Medical consensus once supported daily use of low dose aspirin to prevent heart attack and stroke in people at increased risk for cardiovascular disease (CVD). But in 2018, three major clinical trials cast doubt on that conventional wisdom, finding few benefits and consistent bleeding risks associated with daily aspirin use. Taken together, the findings led the American Heart Association and American College of Cardiology to change clinical practice guidelines earlier this year, recommending against the routine use of aspirin in people older than 70 years or people with increased bleeding risk who do not have existing cardiovascular disease.

Aspirin use is widespread among groups at risk for harm including older adults and adults with peptic ulcers -- painful sores in the lining of the stomach that are prone to bleeding that affect about one in ten people. In a research report published today in Annals of Internal Medicine, researchers from Beth Israel Deaconess Medical Center (BIDMC) report on the extent to which Americans 40 years old and above use aspirin for primary prevention of cardiovascular disease.

"Although prior American Heart Association and American College of Cardiology guidelines recommended aspirin only in persons without elevated bleeding risk, the 2019 guidelines now explicitly recommend against aspirin use among those over the age of 70 who do not have existing heart disease or stroke," said senior author Christina C. Wee, MD, MPH, a general internist and researcher at BIDMC and Associate Professor of Medicine at Harvard Medical School. "Our findings suggest that a substantial portion of adults may be taking aspirin without their physician's advice and potentially without their knowledge."

Using data from the 2017 National Health Interview Survey (NHIS), a nationally representative survey of U.S. households conducted before the release of the new guidelines, Wee and colleagues characterized aspirin use for primary prevention of CVD. The team found that about a quarter of adults aged 40 years or older without cardiovascular disease -- approximately 29 million people -- reported taking daily aspirin for prevention of heart disease. Of these, some 6.6 million people did so without a physician's recommendation.

Concerningly, nearly half of adults 70 years and older without a history of heart disease or stroke reported taking aspirin daily. The authors noted that a history of peptic ulcer disease -- another contraindication for the routine use of aspirin -- was not significantly associated with lower aspirin use as one would have expected.

"Our findings show a tremendous need for health care practitioners to ask their patients about ongoing aspirin use and to advise them about the importance of balancing the benefits and harms, especially among older adults and those with prior peptic ulcer disease," said lead author Colin O'Brien, MD, a senior internal medicine resident at BIDMC and fellow at Harvard Medical School.

Coauthor, Stephen Juraschek, MD, PhD, a primary care physician at BIDMC, cautions that "these findings are applicable to adults who do not have a history of cardiovascular disease or stroke. If you are currently taking aspirin, discuss it with your doctor to see if it is still needed for you."

Juraschek, who is also an Assistant Professor at Harvard Medical School, is supported by grant K23HL135273 from the National Heart, Lung and Blood Institute of the National Institutes of Health.

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Materials provided by Beth Israel Deaconess Medical Center. Note: Content may be edited for style and length.

Aspirin to fight an expensive global killer infection

Research led by the Centenary Institute in Sydney has found a brand new target for treating drug-resistant tuberculosis; our scientists have uncovered that the tuberculosis bacterium hijacks platelets from the body's blood clotting system to weaken our immune systems.

Tuberculosis is far from eradicated around the world and still infects more than 1,400 people per year in Australia. Antibiotic resistant tuberculosis is particularly deadly and expensive to treat, costing up to $250,000 to treat a single case in Australia. Scientists at the Centenary Institute have been working on new ways to treat tuberculosis by increasing the effectiveness of the immune system.

Using the zebrafish model of tuberculosis, the researchers used fluorescent microscopy to observe the build-up of clots and activation of platelets around sites of infection. Senior author and head of the Centenary's Immune-Vascular Interactions laboratory, Dr Stefan Oehlers, says "the zebrafish gives us literal insight into disease processes by watching cells interacting in real time."

Following their hunch that these platelets were being tricked by the infection into getting in the way of the body's immune system, the researchers treated infections with anti-platelet drugs, including widely available aspirin, and were able to prevent hijacking and allow the body to control infection better.

Dr Elinor Hortle, lead author of the paper published in The Journal of Infectious Diseases, and Research Officer in Centenary's Immune-Vascular Interactions laboratory says "This is the first time that platelets have been found to worsen tuberculosis in an animal model. It opens up the possibility that anti-platelet drugs could be used to help the immune system fight off drug resistant TB."

There are over 1.2 million Australians living with latent tuberculosis, a non-infectious form of TB that puts them at risk of developing the active disease. "Our study provides more crucial evidence that widely available aspirin could be used to treat patients with severe tuberculosis infection and save lives," says Dr Hortle.

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Materials provided by Centenary Institute. Note: Content may be edited for style and length.


Low-dose aspirin does not seem to improve survival after prostate cancer diagnosis

Low-dose aspirin use does not seem to reduce the overall risk for prostate cancer death at the population level. However, results for extended exposure periods suggest that low-dose aspirin might be inversely associated with prostate cancer mortality after 5 years from cancer diagnosis. Findings from a nationwide cohort study are published in Annals of Internal Medicine.

Recent studies suggest that aspirin use may improve survival in patients with prostate cancer, but study results are inconclusive.

Researchers from the Danish Cancer Society Research Center, Aarhus University Hospital, Copenhagen University Hospital, and University of Southern Denmark used nationwide registries in Denmark to assess the association between postdiagnosis use of low-dose aspirin and prostate cancer mortality. Their analysis did not find convincing evidence of an overall protective effect of low-dose aspirin for men with prostate cancer. However, they did find a reduced risk for prostate cancer mortality with low-dose aspirin use among patients with low Gleason scores, meaning that their prostate cancer was unlikely to progress, and among those who took low-dose aspirin for an extended period of time.

The authors of an accompanying editorial from Tampere University and Tampere University Hospital in Finland speculate that improved prostate cancer-specific survival among aspirin users with low Gleason scores might be explained by inaccurate tumor grading occurring less frequently in aspirin users than nonusers. Aspirin is an anti-inflammatory drug that lowers serum prostate-specific antigen levels; however, whether this leads to accurate determination of tumor aggressiveness in aspirin users remains to be determined in further studies, according to the authors. They suggest that future research evaluate aspirin exposures longer than those studied to date and investigate the effects of aspirin exposure on disease classification.

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Materials provided by American College of Physicians. Note: Content may be edited for style and length.

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