A large research study published in fall 2018 caused a burst of headlines questioning whether older adults should be taking a daily aspirin, something many have embraced as an easy way to fight off significant health issues.
Taking a daily dose of aspirin has been touted as a way to reduce risks of heart disease, cancer and possibly even dementia. And while there is evidence-based research indicating aspirin can have an effect on those issues, especially cardiovascular problems, two Topeka physicians said it all depends on each patient and his or her individual health history.
"A low-dose aspirin, as harmless as it sounds, I think in the right person can cause a lot of problems," said Stormont Vail Health cardiologist Seshu Rao, adding that it's important for people to always talk to a doctor before adding medication to their daily regimen.
The idea of taking a daily aspirin, often a low-dose baby aspirin, has long been popular. A 2015 study found that 47 percent of adults ages 45 to 75 were taking a daily aspirin even though they had no history of heart problems — the primary condition taking that pill is supposed to affect.
Stormont family medicine physician James McIntosh said the vast majority of his older patients take aspirin without getting input from medical professionals.
"I think it's gotten to the point it's almost like a vitamin or a supplement," he said.
The recent study, which was published in the New England Journal of Medicine and led by Australian researchers, examined whether taking aspirin daily was really the best medicine for about 19,000 healthy people ages 70-plus in Australia and the United States. The study found that for healthy people, there were no benefits to taking an aspirin a day. In addition, there could be serious consequences.
Rao said most of the people he sees in his cardiology practice are taking aspirin daily, and it's an appropriate medication for someone who has had a history of cardiovascular issues. The key in the Australian study, he said, was that people were healthy.
"It's hard to hang your hat on one study," he said, but added: "In the past, nothing has really shown significant benefit for aspirin as a stand-alone primary prevention. It's great for secondary prevention."
That secondary prevention means low doses of aspirin can be helpful not only with a history of cardiovascular disease, including high blood pressure and stroke, but also for those who have diabetes, Rao said.
The key, both he and McIntosh said, is to talk with your doctor because each situation is dependent upon the patient's health history.
"Any medicine should be taken with caution," Rao said. "As benign as aspirin sounds, you should talk to people who've had a GI (gastrointestinal) bleed — it's life-threatening. Even a low-dose aspirin, if you don't have any risk factors but then you've got a bad bowel or a bad GI, can cause catastrophic bleeding."
Aspirin, like other non-steroidal anti-inflammatory drugs commonly referred to as NSAIDs, can cause problems with GI bleeds and other issues.
McIntosh, who finished his residency in 2017, said the concerns about overuse of aspirin were a common topic in medical school and among medical professionals today.
"This (Australian) study kind of confirmed what we were already suspicious of," he said, adding that the American College of Cardiology since 2015 or 2016 has had guidelines against using aspirin as a general use because of the risk of bleeding.
McIntosh said it's critical for physicians to "tease out" from patients as they talk what medications they're using. Low-dose aspirin has become so common that patients may forget to mention they are taking it.
As a primary care doctor, McIntosh said he's not just concerned about the use of a daily aspirin, but also about the use of other NSAIDs like ibuprofen, Aleve and others.
"A lot of people have aches and pains," he said. "I can't tell you how many of my older patients will tell me 'I take almost 400 mg of ibuprofen daily.' When you start combining those, you've got the daily aspirin and you've got other NSAIDs, before you know it, you've got major risks of bleeding."
There are dietary factors that can thin blood, too, and adding those issues all together increases risks of serious issues, McIntosh said.
He encouraged patients to bring a list of their questions to the doctor, along with a list of medications — both over-the-counter and prescribed — vitamins and anything else they regularly take.
"The No. 1 thing I tell my patients, regardless of what they're taking ... is talk to your doctor about it," he said. "Something that can be helpful in some populations can be harmful in other populations."