As ever, more confusion about ASA

On the one hand, a large study that was published a while ago known as ASPREE (don’t ask) concluded that elderly users of daily low-dose aspirin, which we always defer to as ASA, were actually at increased risk of dying compared to people who weren’t using daily ASA, which ran counter to several previous studies showing (usually a small) advantage in terms of life expectancy for daily users of ASA.

So we were all waiting for another shoe to drop in this multi-shoed debate, and it dropped this week with a new study concluding that yup, regular users of ASA actually had a longer life expectancy than non-users in that the ASAers had lower death rates from both cardiovascular diseases and cancers than the non-ASAers.

The main reason, I think, that these studies cannot agree on the main outcome (does taking daily ASA help you live longer?) is that although the researchers play all sorts of fancy games in trying to balance out the two groups (yes- ASA versus no-ASA) for many different factors (age, concurrent health conditions, demographic factors), a huge impediment in balancing such groups is that common sense tells you that since ASA is linked to several nasty potential complications (among them , a higher risk of a nasty kind of stroke), people will self-select about whether they want to take the risk for those complications (especially since ASA is sold over-the-counter so it’s very hard for the researchers to monitor exact use of the drug), and that in turn means the groups can never really be randomized nearly as well as they need to be in order to draw a definitive conclusion.

So should you take daily ASA?

As always, it’s really up to you , and this one is as close as a typical North American election in that surveys claim that roughly half of North American adults claim they do take daily ASA, and the other half claim not to.