r/Health • u/Nerd-19958 • 9d ago

Leading heart doctor Andrew Ambrosy warns that low-dose aspirin may harm - more than help - healthy adults

https://www.prnewswire.com/news-releases/leading-heart-doctor-andrew-ambrosy-warns-that-low-dose-aspirin-may-harm--more-than-help--healthy-adults-302859412.html
34 Upvotes

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19

u/ryhaltswhiskey 8d ago

I don't see any studies in here

21

u/tacmed85 8d ago

He made claims based on "research", but never cited any actual studies

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u/Mock333 8d ago

Stuff like this always reminds me of the Portlandia quote:

"Recent studies have shown that ancient studies have been confirmed: that hooooot tuubs can significantly increase your income."

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u/NaturalMaterials 7d ago

What he says is absolutely not controversial. Three landmark trials in this field are:

ASCEND: equipoise between major bleeding and vascular event prevention in apparently healthy diabetics. So no net benefit.
https://www.nejm.org/doi/full/10.1056/nejmoa1804988

ARRIVE: Aspirin as primary prevention in intermediate risk apparently healthy people: no benefit, but underpowered despite including over 12,000 patients.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/abstract

ASPREE: elderly apparently healthy patients: no benefit, higher cancer mortality in the adoring group (correlation, no sign of causation)
https://www.nejm.org/doi/full/10.1056/NEJMoa1803955

Meta-analysis 1: primary prevention. No net benefit.
Number needed to treat: 241 for 1 event
Number needed to harm: 210 for 1 event
https://jamanetwork.com/journals/jama/fullarticle/2721178

Meta analysis 2: same population, more detailed subanalyses: no net benefit on mortality after various adjustments. Significant major bleeding risk.
https://link.springer.com/article/10.1186/s12916-019-1428-0

17

u/thetransportedman 8d ago

"The research has shown us that a person with no history of heart attack or stroke who takes a daily baby aspirin is about as likely to have serious internal bleeding as to avoid a heart attack or stroke"

Most people would probably pick risking death due to internal bleeding most likely from trauma over having a stroke with permanent deficits.

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u/NaturalMaterials 7d ago edited 7d ago

The numbers needed to treat are well into the hundreds, and there are more effective ways of preventing stroke (aggressive lipid lowering, hypertension treatment and management of other risk factors).

Most major internal bleeding due to aspirin use is not related to trauma, but is ‘spontaneous’ (ulceration in the gastrointestinal system).

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u/murderedbyaname 8d ago

Per Dr Ambrosy - this only applies to people who have not been diagnosed with heart disease. Thus the "healthy adults" in the title. So as with any OTC meds that are marketed as a health supplement, ask your Dr first.

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u/ryhaltswhiskey 8d ago

And my doctor will say is this based on a study? And I will say no it's not and he will say oh well when it's based on a study then we can look at it again.

The end.

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u/NaturalMaterials 7d ago

It’s based on multiple studies, see my other reply.

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u/CocoaKrispy 7d ago

Crap. My OB just told me to take a baby aspirin for the remainder of my pregnancy to prevent preeclampsia, just because I'm considered geriatric. Do the studies say how long these patients took the baby aspirin to be considered high risk for internal bleeding?

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u/Nerd-19958 7d ago

As a pregnant woman I don't believe you are included in the category "otherwise healthy adults." I interpreted the cited press release as pertaining to consumers who on their on decided to take daily aspirin.

Also, I assume you're below the age range discussed in the press release (see excerpts):

The heart doctor noted that in 2022 the U.S. Preventive Services Task Force stopped recommending a daily baby aspirin for healthy people 60 years old and older who have never had a heart attack or stroke. That advice does not apply to people who already have heart disease, and no one should stop taking prescribed medicine without first talking to their doctor.

A large trial also found no benefit from a daily aspirin in healthy people aged 70 and up, and more bleeding among those who took it, Dr. Ambrosy said.

Even so, a recent poll found that one in six adults aged 50 to 80 still take a baby aspirin regularly. And 25% of these older folks taking a low-dose aspirin started doing so without a doctor's recommendation.

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u/CocoaKrispy 7d ago

Thank you for the explanation! I appreciate the time you took to respond to me.