Aspirin and Unintended Consequences
We began the week considering a type of shortcut to health called biohacking. The polypill was a biohack to reduce the risk of CVD events, but there’s no research showing whether the polypill will ever prove to be effective. However, the results of the ASPREE trial may give us an idea whether the long-term trials should ever be attempted (1-3). Let’s take a look at the results of the ASPREE trial and the effects of an aspirin a day on healthy older adults.
In the first paper, the researchers evaluated the data to see if those who took the aspirin had less disability (1). In other words, did taking the aspirin convey benefits that reduced the risk of death, disability, or dementia? The data showed no differences between the aspirin and placebo group as it related to those outcomes.
In the second paper, the researchers examined the differences in all-cause mortality (2). What surprised the researchers was a slight increase in death from cancers in the group that took the aspirin; no specific type of cancer seemed to be impacted. Because aspirin has been shown to be beneficial in almost all other studies of cancer and mortality, the researchers said the results should be taken with a degree of caution.
In the final paper, researchers examined whether aspirin reduced the rate of CVD events and stroke (3) and found no difference, but the risk of hemorrhagic stroke was significantly higher in the aspirin group versus the placebo. This was the primary reason the study was terminated after five years.
The Problem
There were several problems with the study including the low adherence in both the aspirin and placebo group: if people didn’t take the pills, obviously that impacts the results. But the biggest question I have is a very simple one: who thought it was a good idea to give healthy people a medication every single day? Taking an aspirin for a headache or muscle ache is one thing. Taking it when you don’t need it is another.
The study demonstrated the logical fallacy of the polypill. “People won’t take care of themselves, so let’s put everyone on the medications that can reduce the risk of CVD.” No, let’s not. The results were unintended consequences that put the entire idea of biohacking into question.
The Bottom Line
When it comes to health, there are no real shortcuts. Biohacking, while a cute contemporary term, is fool’s gold. Yes, you can use your time and resources more efficiently to improve your health, but there are no shortcuts.
There is also one other obvious conclusion. Healthy people shouldn’t take medication. I take an 81 mg aspirin every day because I have had a stent and my doctor told me to. But I don’t take a statin any more because I changed my diet and lifestyle to keep my cholesterol normal. I control my blood pressure with diet and exercise. I don’t take medications I don’t need.
If you’re willing to do all you can to avoid medications and you still need medication to help you out, do it. But don’t take them to avoid doing the work. There are unintended consequences of taking the easy way out.
What are you prepared to do today?
Dr. Chet
References:
1. DOI: 10.1056/NEJMoa1800722.
2. DOI: 10.1056/NEJMoa1803955.
3. DOI: 10.1056/NEJMoa1805819.
