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Patient Evidence Summary
Doctor, I am healthy and over the age of 70, should I take aspirin to prevent death, dementia, and physical disability?
In healthy people over the age of 70, taking a low-dose aspirin daily does not prolong survival, reduce risk of dementia or physical disability, and it may increase risk of major bleeding. These results do not apply to people who have already been diagnosed with heart disease or stroke.
Study highlights
Taking an aspirin a day (100 mg) in healthy elderly persons (above the age of 70) did not reduce death, dementia, or physical disability over a period of 5 years. (91% of the people in this study were Caucasian therefore the results may not apply to people from other ethnic backgrounds).
Understanding the problem
You may have seen advertisements that promote aspirin as a medication for heart disease. Indeed, aspirin is an important medication for people having a heart attack and to prevent another heart attack or stroke in people who have already had one. But what about healthy older people? Is it a good idea for them to take an aspirin a day?
In this study, researchers investigated whether there was a health benefit in taking a daily aspirin for people over age 70 who are living in the community who have never had a stroke or heart attack.
Who? The study included 19,114 people who were over the age of 70 (mean age 74; 56% women) from the US or Australia who had none of the following:
- Heart disease (e.g. heart attack or angina or heart failure)
- Stroke
- Dementia
- Physical disability (defined as severe difficulty or inability to perform any of the following activities of daily living: bathing, dressing, toileting, transfering, walking, feeding)
What? The study measured the rate of death, dementia and persistent (longer than 6 months) physical disability in people who took aspirin compared to people who took placebo.
Aspirin | vs | Placebo |
|---|---|---|
Aspirin 100 mg once a day | Placebo: A pill containing an inactive substance that has no effect on the outcome. Sometimes, it is referred to as a “sugar pill.” |
Outcomes at 4.7 Years (19,114 People) | Rate of events with Aspirin | Rate of events with Placebo | Results |
|---|---|---|---|
Primary Outcome* | 10 out of 100 people | 10 out of 100 people | No difference |
| 5 out of 100 people | 5 out of 100 people | No difference |
| 3 out of 100 people | 3 out of 100 people | No difference |
| 2 out of 100 people | 2 out of 100 people | No difference |
| Major bleeding | 4 out of 100 people | 2 out of 100 people | About 2 more people out of 100 had major bleeding while taking aspirin |
*The primary outcome is a combination of any of the following: death from any cause, dementia, or physical disability.
This Evidence Summary is based on the following article:
McNeil JJ, Woods RL, Nelson MR, et al. Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med. 2018 Oct 18;379(16):1499-1508. doi: 10.1056/NEJMoa1800722. Epub 2018 Sep 16. PubMed
Philip is an internal medicine resident at the University of Ottawa. He completed his MD at the University of Ottawa and has been involved in thrombosis research during his medical studies. He hopes to pursue a thrombosis fellowship after his residency.
Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Dr. Linkins is an Associate Professor of Medicine (thrombosis) at McMaster University in Hamilton, Canada. She holds a Masters Degree in Health Research Methodology and is a Deputy Editor with the Health Information Research Unit, McMaster. She is Co-Editor of the ACP Journal Club and Co-lead on the CanVECTOR Knowledge Translation Platform.
Published: Wednesday, July 29, 2020
Last Updated: Thursday, July 30, 2020
Please note that the information contained herein is not to be interpreted as an alternative to medical advice from a professional healthcare provider. If you have any questions about any medical matter, you should consult your professional healthcare providers, and should never delay seeking medical advice, disregard medical advice or discontinue medication based on information provided here.
, McMaster University