This OTC Medicine Linked to 20% Higher Anemia Risk in Seniors, Says Research

Updated: Sep. 11, 2023

New NIH-funded research uncovers potential anemia risks linked to daily low-dose aspirin among older adults.

It’s a small, white pill that has long been a staple in many medicine cabinets. Its reputation as a preventive measure against heart diseases made it an almost ritualistic daily intake for older adults. Hailed for its potential cardiovascular benefits, the tablet has, for years, been recommended by many physicians as a simple, low-cost intervention. However, with each passing decade the research around medication advances, and what was once considered a universal truth is being reevaluated.

Understanding anemia

According to the National Institutes of Health, anemia—a condition marked by insufficient healthy red blood cells—results in reduced oxygen transport to body tissues. The repercussions? Fatigue, breathlessness and, for seniors, potentially exacerbated health complications. The CDC notes that roughly 3 million Americans suffer from anemia. Aspirin’s contribution to this narrative, especially for older adults, has become central to a recent study published in July 2023 in the peer-reviewed journal Annals of Internal Medicine.

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The ASPREE Study

The ASPREE (ASPirin in Reducing Events in the Elderly) study, an initiative across Australia and the US, explored aspirin’s impact on seniors. The research focused on community-dwelling individuals aged 70 and above (or 65 for Black and Hispanic individuals).

One group was given a 100 mg dose of aspirin daily, while the other received a placebo. Researchers monitored potential differences between these groups’ anemia onset, hemoglobin concentrations and serum ferritin levels.

The outcomes revealed that those on aspirin had a 20% heightened risk of developing anemia when matched against the placebo group. Specifically, the aspirin group registered 51.2 anemia incidents per 1000 person-years as opposed to 42.9 in the placebo group. The decline in hemoglobin, which is critical for oxygen transport in the body, was also more pronounced for aspirin users. Examining iron storage, the research revealed that the aspirin cohort experienced a sharper drop in ferritin, a protein indicating iron levels.

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A cardiologist’s perspective

John D. Bisognano, MD, PhD, FACC, clinical professor of medicine and director of General, Consultative, and Preventive Cardiology at the University of Michigan, provides insights published on the American College of Cardiology’s site into the recent findings of the ASPREE study. He recalls earlier results from the 2018 ASPREE trial, noting that aspirin use has long been linked to a heightened risk of significant bleeding and its ambiguous benefits concerning cardiovascular disease reduction.

A particularly concerning revelation from the study was the higher overall death rate among those taking aspirin, notably from cancer. Dr. Bisognano points out that the medical community has treated this surprising result with a healthy dose of caution.

While the risk of bleeding from aspirin use is well-known, Dr. Bisognano emphasizes the overlooked concern of anemia, especially among older adults. The consequences of anemia in this age group range from functional decline to more profound psychological impacts, like depression.

In light of these findings, Dr. Bisognano urges a cautious approach. He suggests that doctors reconsider the routine prescription of daily aspirin, especially if the risks outweigh the benefits. If aspirin is deemed necessary for some seniors, they should be closely monitored for anemia and decreased ferritin levels to ensure their overall well-being.

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