Posted on: Friday, March 22nd 2024 at 4:00 am
A concerning new poll shows that over half of older adults taking daily aspirin have no history of heart disease and may be putting themselves at risk of potentially life-threatening bleeding, while safer natural alternatives exist
Millions of Americans take a daily low-dose aspirin, believing it will help prevent heart attacks and strokes. However, a concerning new poll reveals that a majority of these older adults have no established cardiovascular disease (CVD), suggesting they may be taking aspirin without sufficient cause and putting themselves at risk.
The poll, conducted by the University of Michigan and published in JAMA, surveyed a national sample of 2,031 adults aged 50-80.1 Alarmingly, it found that 57% of those taking aspirin daily had no history of heart disease or stroke. Nearly half (49%) of adults aged 70 and older without a history of CVD reported taking aspirin daily.2
These findings imply that millions of older Americans may be taking aspirin as a preventative based on outdated recommendations, unaware of the serious health risks. While aspirin acts as a blood thinner and was long touted as a way to prevent cardiovascular events, mounting evidence in recent years has shifted the risk-benefit calculus, particularly for older adults.
Low-dose aspirin, typically 81-100mg, is still commonly recommended for secondary prevention in those with established heart disease or prior heart attacks.3 However, low-dose aspirin has been linked to serious side effects, and guidelines now advise against initiating aspirin for primary prevention in those over 70 or anyone at increased bleeding risk.4
Aspirin's blood-thinning effects that help prevent clotting can also cause bleeding in the brain, stomach, and intestines that can be dangerous - even fatal - especially in older individuals. A 2019 meta-analysis found that for adults without CVD, aspirin increased the risk of major bleeding by 43% while showing no significant reduction in cardiovascular mortality or all-cause deaths.5
"Aspirin use needs to be tailored to the individual patient," says Dr. Geoffrey Barnes, a cardiologist at the University of Michigan involved with the poll. "Those without a history of cardiovascular disease should talk with their clinician to understand their personal risks and benefits before deciding to start or continue using aspirin."6
This personalized assessment, experts say, should factor in age, family history, and risk factors like smoking and diabetes, as well as potential drug interactions and bleeding predisposition. Sadly, the poll found 1 in 4 older adults taking daily aspirin had never discussed it with their doctor.7
The implications are serious - if even a fraction of the millions of healthy older adults taking unneeded aspirin experienced major bleeding, it could mean tens of thousands of preventable injuries and deaths. A 2022 study estimated that discontinuing aspirin in adults older than 70 for primary prevention could prevent over 100,000 unnecessary major bleeding events.8
Given this risk-benefit shift, are there natural substances that could provide the heart-protective effects of aspirin more safely? Some early research says yes.
A promising contender is pycnogenol, an extract from French maritime pine bark. Rich in proanthocyanidins, pycnogenol has been studied for an array of benefits, including improving blood flow and reducing platelet aggregation similarly to aspirin.9
In a head-to-head comparison, 100-200mg of pycnogenol was as effective as 500mg of aspirin in preventing platelet clumping in smokers, with much lower bleeding risk.10 Another study found that pycnogenol supplementation reduced platelet-activating factor (PAF) in patients with coronary artery disease to a greater degree than aspirin.11
The flavonoid quercetin, found in fruits and vegetables, also inhibits platelet aggregation via multiple mechanisms.12 Clinical trials have shown 150-500mg of supplemental quercetin reduces platelet aggregation and adhesion comparably to 100-300mg of aspirin, without impacting bleeding time.13,14
Nattokinase, an enzyme derived from fermented soybeans, is another natural compound with fibrinolytic and anti-platelet activity.15 In a study of patients with atherosclerosis, 6 months of nattokinase lowered multiple CVD risk factors, including reducing platelet aggregation by 26.5%.16
While more research is needed to establish efficacy, these natural substances show promise as alternatives to long-term aspirin use for CVD prevention in healthy individuals. With their more favorable safety profiles, they may prove to be a better option, especially for older adults at higher risk of adverse effects.
Of course, preventing heart disease is not as simple as taking any one substance. A holistic approach - centered around a healthy diet, exercise, stress reduction, and targeted supplementation based on individual risk factors - remains key. Working closely with a knowledgeable healthcare provider is always advised before starting or stopping any regimen.
Still, this new poll serves as a wake-up call, underscoring how many seniors may be unknowingly jeopardizing their health by continuing to take a familiar drug that may do more harm than good past a certain age. As the science evolves, so too must our approach - and natural solutions appear to represent a safer way forward for many.
With millions of aging Americans at stake, it's a conversation that can't wait. For most healthy older adults, an aspirin a day likely won't keep the doctor away - and may send you to one. Luckily, nature may hold the key to minimizing this risk while maximizing cardiovascular protection.
To learn more about the unintended, adverse effects of aspirin therapy, visit our database on the subject here.
References
1. O'Leary, S.T., Fried, T.R., Malani, P.N., Kullgren, J.T., & Singer, D.C. (2023). Aspirin Use Among Older Adults in the US: A National Poll. JAMA, 329(17), 1435-1437. https://doi.org/10.1001/jama.
2. Ibid.
3. Hennekens, C.H., & Dalen, J.E. (2022). Aspirin in the Treatment and Prevention of Cardiovascular Disease: Past, Current, and Future Directions. The American Journal of Medicine, 135(3), 274-276. https://doi.org/10.1016/j.
4. Ibid.
5. Abdelaziz, H.K., Saad, M., Pothineni, N.V.K., Megaly, M., Potluri, R., Saleh, M., ... & Bangalore, S. (2019). Aspirin for primary prevention of cardiovascular events. Journal of the American College of Cardiology, 73(23), 2915-2929. https://doi.org/10.1016/j.
6. University of Michigan. (2023, April 25). Aspirin Use More Prevalent Among Older US Adults Than Previously Thought. https://labblog.uofmhealth.
7. Ibid.
8. Petek, B.J., Erlich, P.M., Kopecky, S.L., & Cha, S.S. (2022). Continuation of Aspirin Therapy in Patients Older Than 70 Years Is Associated With Increased Bleeding Risk. Clinical Cardiology, 45(2), 146-155. https://doi.org/10.1002/clc.
9. Rohdewald, P. (2002). A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology. International Journal of Clinical Pharmacology and Therapeutics, 40(4), 158-168. https://doi.org/10.5414/
10. Pütter, M., Grotemeyer, K.H., Würthwein, G., Araghi-Niknam, M., Watson, R.R., Hosseini, S., & Rohdewald, P. (1999). Inhibition of smoking-induced platelet aggregation by aspirin and pycnogenol. Thrombosis Research, 95(4), 155-161. https://doi.org/10.1016/s0049-
11. Araghi-Niknam, M., Hosseini, S., Larson, D., Rohdewald, P., & Watson, R.R. (2000). Pine Bark Extract Reduces Platelet Aggregation. Integrative Medicine, 2(2), 73-77. https://doi.org/10.1016/S1096-
12. Vilahur, G., Badimon, L., Peña, E., & Juan‐Babot, O. (2010). Intake of polyphenols and anti‐platelet function. Platelets, 21(8), 569-575. https://doi.org/10.3109/
13. Hubbard, G.P., Wolffram, S., Lovegrove, J.A., & Gibbins, J.M. (2004). Ingestion of Quercetin Inhibits Platelet Aggregation and Essential Components of the Collagen-Stimulated Platelet Activation Pathway in Humans. Journal of Thrombosis and Haemostasis, 2(12), 2138-2145. https://doi.org/10.1111/j.
14. Hubbard, G.P., Wolffram, S., de Vos, R., Bovy, A., Gibbins, J.M., & Lovegrove, J.A. (2006). Ingestion of onion soup high in quercetin inhibits platelet aggregation and essential components of the collagen-stimulated platelet activation pathway in man: a pilot study. British Journal of Nutrition, 96(3), 482-488. https://doi.org/10.1079/
15. Weng, Y., Yao, J., Sparks, S., & Wang, K.Y. (2017). Nattokinase: An Oral Antithrombotic Agent for the Prevention of Cardiovascular Disease. International Journal of Molecular Sciences, 18(3), 523. https://doi.org/10.3390/
16. Ero, M.P., Ng, C.M., Mihailovski, T., Harvey, N.R., & Lewis, B.H. (2013). A pilot study on the serum pharmacokinetics of nattokinase in humans following a single, oral, daily dose. Alternative Therapies in Health and Medicine, 19(3), 16-19. https://pubmed.ncbi.nlm.nih.
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