The link between low-dose aspirin and stroke risk
Summary
TLDRIn this interview at Melbourne University, Professor Jeffrey Donan, a neurologist specializing in stroke research, discusses the ASPREE study. The study involved 19,000 participants over 70 years old and aimed to determine if aspirin could prevent heart attacks and strokes in healthy seniors. The findings showed that the risks of bleeding, including in the brain and gut, outweighed the benefits. Professor Donan emphasizes that aspirin is beneficial for those who have previously had a stroke or heart attack but not for healthy seniors. He advises focusing on controllable risk factors like high blood pressure, smoking, and atrial fibrillation to prevent strokes, highlighting the importance of a healthy lifestyle.
Takeaways
- 👨⚕️ Professor Jeffrey Donan is a neurologist specializing in stroke research at the Royal Melbourne Hospital.
- 🧪 The ASPREE study involved 19,000 participants and aimed to determine if aspirin could prevent heart attacks and strokes in healthy individuals over 70.
- 🚫 The study found that the risks of taking aspirin, including bleeding in the brain and gut, outweighed the benefits for healthy elderly individuals.
- ❌ Aspirin was not found to be effective in preventing strokes in the ASPREE study, contrary to previous assumptions.
- 🩺 For those who have had a minor stroke, transient ischemic attack, or heart attack, aspirin is still recommended and beneficial when taken immediately and continued long-term.
- 👴 If you are over 70 and healthy, there is no evidence to suggest that taking aspirin will prevent strokes.
- 🏥 It's important for older individuals to consult with their doctors about whether aspirin is appropriate for them.
- 💡 To reduce stroke risk, manage controllable factors such as high blood pressure, smoking, diabetes, and atrial fibrillation.
- 🌟 The future of stroke prevention may lie in identifying and controlling risk factors rather than relying on a single 'magic bullet' solution.
- 🌿 Leading a healthy lifestyle, including stress management and lifestyle changes, can significantly reduce the likelihood of illness and stroke.
Q & A
What is Professor Jeffrey Donan's area of expertise?
-Professor Jeffrey Donan is a neurologist at the Royal Melbourne Hospital, and he has been researching stroke for most of his career.
What was the main objective of the ASPREE study?
-The main objective of the ASPREE study was to determine whether taking aspirin could prevent heart attacks and strokes in healthy people over the age of 70.
How many participants were involved in the ASPREE study?
-The ASPREE study involved 19,000 participants.
What was the comparison in the ASPREE study?
-The study compared the effects of aspirin versus a placebo to see if aspirin helped in preventing strokes and heart attacks.
What was the conclusion of the ASPREE study regarding aspirin and stroke prevention?
-The ASPREE study concluded that the risk of taking aspirin outweighed the benefit, and it was not effective in preventing strokes in healthy individuals over the age of 70.
Did the ASPREE study find any harm in taking aspirin for the elderly?
-Yes, the study found that aspirin could cause bleeding in the brain and the gut, which made it not a good thing to do for healthy elderly individuals.
Who should be taking low-dose aspirin according to Professor Donan?
-According to Professor Donan, people who have had a minor stroke, a transient ischemic attack, or a heart attack, and those with serious heart conditions, should take aspirin as it is enormously beneficial.
What are some ways to reduce the risk of stroke as mentioned in the interview?
-To reduce the risk of stroke, one should control high blood pressure, avoid smoking, manage diabetes, and be aware of atrial fibrillation, which is an irregular pulse.
What is the importance of managing atrial fibrillation to reduce stroke risk?
-Managing atrial fibrillation is crucial because it increases the risk of stroke five times, but this risk can be significantly reduced with medications.
What does Professor Donan see as the future of stroke prevention?
-Professor Donan sees the future of stroke prevention in identifying and controlling risks, including those that are yet to be fully discovered, as well as focusing on stress and lifestyle changes.
What is the key message Professor Donan gives for leading a healthy lifestyle to reduce illness?
-The key message is that leading a healthy lifestyle, which includes managing known risks and making lifestyle changes, can greatly reduce the likelihood of becoming ill.
Outlines
🧠 Stroke Prevention and Aspirin Study Insights
Professor Jeffrey Donan, a neurologist at the Royal Melbourne Hospital, discusses his research on stroke, particularly focusing on the ASPREE study. The study aimed to determine whether aspirin could prevent heart attacks and strokes in healthy individuals over 70. Involving 19,000 participants, it compared aspirin to a placebo. The findings indicated that the risks of aspirin, including bleeding in the brain and gut, outweighed its benefits for stroke prevention. Professor Donan advises against aspirin for healthy elderly without specific conditions and emphasizes the importance of consulting doctors for personalized advice. He also highlights the continued benefits of aspirin for those who have experienced minor strokes, transient ischemic attacks, or heart attacks.
💊 Aspirin Use in Specific Health Conditions
Professor Donan clarifies that low-dose aspirin remains beneficial for individuals who have previously suffered a stroke, transient ischemic attack, or heart attack, and should be taken immediately and continued long-term. However, for healthy individuals over 70, there is no evidence supporting the use of aspirin for stroke prevention. He suggests that elderly individuals who are taking aspirin should consult their doctors to reconsider its use.
🚫 Risk Factors and Stroke Prevention Strategies
The conversation shifts to strategies for reducing the risk of stroke. Professor Donan emphasizes controlling high blood pressure, refraining from smoking, managing diabetes, and addressing atrial fibrillation as key preventive measures. Atrial fibrillation, an irregular pulse, significantly increases the risk of stroke, but this risk can be substantially reduced with medication. He stresses the importance of early detection and treatment of atrial fibrillation to minimize stroke risk.
🔮 Future Directions in Stroke Prevention
Looking ahead, Professor Donan envisions a future in stroke prevention that focuses on identifying and controlling risk factors rather than relying on a 'magic bullet' solution. He suggests that further research may uncover additional controllable risks and that lifestyle modifications, such as stress management, will play a crucial role in reducing the likelihood of stroke. He concludes by reiterating the importance of a healthy lifestyle in preventing illness.
Mindmap
Keywords
💡Neurologist
💡Stroke
💡ASPEE Study
💡Aspirin
💡Placebo
💡Risk-Benefit Analysis
💡Bleeding
💡Atrial Fibrillation
💡High Blood Pressure
💡Lifestyle Factors
Highlights
Professor Jeffrey Donan, a neurologist at the Royal Melbourne Hospital, discusses his research on stroke prevention.
The ASPEE study aimed to determine if aspirin could prevent heart attacks and strokes in healthy individuals over 70.
The study involved 19,000 participants and compared aspirin to a placebo.
The study found that the risk of aspirin outweighed the benefits for stroke prevention.
Aspirin was associated with an increased risk of bleeding in the brain and gut.
There's no evidence that healthy individuals over 70 should take aspirin to prevent stroke.
Older people should consult their doctors if they are currently taking aspirin for stroke prevention.
Low-dose aspirin is beneficial for those who have had a minor stroke, TIA, or heart attack.
People with serious heart conditions should take aspirin early and continue long-term.
Controlling high blood pressure significantly reduces the risk of stroke.
Smoking cessation and diabetes control are crucial in reducing stroke risk.
Atrial fibrillation, an irregular pulse, increases the risk of stroke fivefold.
Medications can reduce the risk of stroke in those with atrial fibrillation by 60-80%.
The future of stroke prevention lies in identifying and controlling risks rather than relying on a 'magic bullet'.
Leading a healthy lifestyle is key to reducing the likelihood of illness.
Professor Jeffrey Donan emphasizes the importance of common sense in maintaining good health.
Transcripts
well today it's my absolute privilege to
be sitting in this beautiful garden here
at Melbourne University with Professor
Jeffrey Donan Jeffrey welcome to the
show thank you Nick it's a pleasure to
be here now first off can you just tell
us what your area of expertise is well
I'm a neurologist over at the Royal
Milbourne hospital and I've been
researching stroke for most of my career
so stroke is really your prime interest
isn't it my prime interest is stroke now
let's talk about the aspee study tell me
what that was all about well we have
aspirin almost everywhere in society and
the the big question is should we take
aspirin to prevent people who are
normally healthy over the age of 70
having heart attacks and strokes and
that was the purpose of the whole study
so this was a huge study wasn't it it
was 19,000 people and it was aspirin
versus placebo to see if it helped
that's right we what we wanted to know
was look at the risk benefit because we
we know that there's a potential benefit
but we also KN know there was a
potential risk which was going to win
and in a nutshell what did we find
well the risk really outweighed the
benefit okay so Aspen wasn't wasn't good
for preventing stroke it wasn't good for
preventing stroke so Jeffy if we've
shown that Aspen wasn't doing people any
good in this study was it actually doing
them any harm unfortunately it was uh
the bleeding was uh unfortunately in the
brain in the various compartments uh and
also the gut the combination of those
two things made it not a good thing to
do so if you're uh over the age of 70 uh
you're otherwise healthy there's no real
evidence you should take aspirin and
that's a really important point isn't
because there are older people taking
ASP because they thought it was a good
idea so probably for those people they
should pop down to their doctor and just
check and maybe think about so can you
tell who should be taking lowd dose
aspirin these days well I think there's
not a Shadow of Doubt for those people
still who have a minor stroke or trans
indemic attack uh a heart attack these
are the people where given aspirin uh
almost straight away is enormously
beneficial so people with previous esic
stroke transend es schic attack people
with serious heart condition stance that
sort of thing be on they should take
aspirin very early on and they should
continue to take it at infinum so if
you're a healthy person and you're 70 or
older that you don't want to get a
stroke taking aspirin doesn't get work
so what should people do to reduce their
risk of stroke very good question so you
should really address the things that
are likely to cause stroke and number
one is you're getting older you can't do
much about that number two is if you
develop high blood pressure you if you
control your high blood pressure
incredibly well massively reduces the
chance of you having a stroke if you're
a smoker of course don't do it again
reduce the chance enormously if you're
diabetic uh if you control that
incredibly well uh you reduce the risk
and the last one and probably even one
of the most important one is so-called
atrial fibrillation which is an
irregular pulse so if you happen to be
sitting there and you feel your pulse
and say GE that's jumping around a bit
go to your doctor yeah really really
important Point really important point
because something over 10% of older
adults will get a fibrillation at some
point and it's a huge risk of stroke
that increases five times the risk of
you having a stroke so and it's so easy
to fix you can reduce with medications
the chance of you developing a stroke if
you got that irregular pulse by up to
about 60 80% now tell me in that case if
we're not going to take aspirin what do
you see as the future in stroke
prevention is there anything fantastic
coming along I think it's going to be
all about identifying risk and then
controlling risks there might still be
risks uh that are controllable we
haven't fully discovered and there are
others like stress and uh lifestyle
changes that we we know you need to
control a lot better so focusing on
those sorts of things are going to be I
think the way of the future rather than
some magic bullet that uh lazily we just
take and it takes away the risk it's
it's it's the the message again and
again it's just such common sense is if
you lead a healthy lifestyle the
likelihood of you becoming ill is so
much lessened that's such a good piece
of advice Professor Jeffrey Donan thank
you so much for coming on the show Nick
thank you for having me
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