The link between low-dose aspirin and stroke risk

Summary

In 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

00:00

🧠 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.

Keywords

💡Neurologist

A neurologist is a medical professional who specializes in the diagnosis and treatment of disorders of the nervous system, including the brain, spinal cord, and nerves. In the context of the video, Professor Jeffrey Donan is a neurologist, which establishes his authority on the topic of stroke. His expertise is crucial for understanding the medical aspects discussed in the video, such as the effects of aspirin on stroke prevention.

💡Stroke

A stroke occurs when the blood supply to a part of the brain is interrupted or reduced, preventing brain tissue from getting the oxygen and nutrients it needs to function. In the video, stroke is the central topic, with the discussion revolving around the ASPEE study, which investigates the use of aspirin to prevent strokes in healthy individuals over the age of 70.

💡ASPEE Study

The ASPEE Study, or Aspirin in Reducing Events in the Elderly, is a large-scale clinical trial that aimed to determine whether daily low-dose aspirin could prevent heart attacks, ischemic strokes, or death from cardiovascular causes in people over 70 who were otherwise healthy. The study's findings, as mentioned in the video, indicated that the risks of aspirin use outweighed the benefits for this demographic.

💡Aspirin

Aspirin, or acetylsalicylic acid, is a medication commonly used to treat pain, fever, and inflammation. It is also used long-term to prevent heart attacks, strokes, and blood clots in people at high risk. The video discusses the controversy surrounding the use of aspirin for stroke prevention, particularly in elderly individuals without existing heart conditions.

💡Placebo

A placebo is a substance or treatment that has no therapeutic effect but is given to a patient in a clinical trial to compare with a drug or treatment that is being tested. In the ASPEE Study, aspirin was compared to a placebo to determine its effectiveness in preventing strokes, as mentioned in the video.

💡Risk-Benefit Analysis

Risk-benefit analysis is a process of evaluating the potential harms and benefits of a particular intervention or action. In the video, the discussion around the ASPEE Study focuses on the risk-benefit analysis of taking aspirin for stroke prevention, concluding that the risks, such as bleeding, outweighed the benefits for the elderly without prior conditions.

💡Bleeding

Bleeding, particularly internal bleeding, is a serious medical condition where blood escapes from blood vessels. In the context of the video, it is mentioned as a risk associated with aspirin use, with the study finding that aspirin use led to an increase in bleeding events, including in the brain and gastrointestinal tract.

💡Atrial Fibrillation

Atrial fibrillation is a heart condition that causes an irregular and often rapid heart rate, which can increase the risk of stroke. The video emphasizes the importance of recognizing and managing atrial fibrillation to reduce the risk of stroke, as individuals with this condition are at a significantly higher risk.

💡High Blood Pressure

High blood pressure, or hypertension, is a medical condition where the force of the blood against the walls of the arteries is consistently too high. The video mentions high blood pressure as a significant risk factor for stroke, and controlling it is crucial in reducing the likelihood of stroke.

💡Lifestyle Factors

Lifestyle factors refer to the choices and behaviors that individuals engage in that can influence their health. In the video, Professor Donan suggests that focusing on lifestyle factors, such as diet, exercise, and stress management, is essential for stroke prevention. This aligns with the broader message that a healthy lifestyle can significantly reduce the risk of illness.

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