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Low-dose aspirin may raise risk of anemia in older adults

Recent follow-up analysis of data from an international, National Institutes of Health-funded clinical trial suggests daily low-dose aspirin increases the risk of anemia in people age 65 years and older by approximately 20%.

Given these findings, older adults on low-dose aspirin and their care providers may want to consider periodic monitoring of red blood cells or hemoglobin.

Anemia in older adults is associated with functional decline, increased fatigue, disabilities, depressive symptoms, and cognition problems.

Published in the Annals of Internal Medicine, scientists from the Aspirin in Reducing Events in the Elderly (ASPREE) study examined the effect of long-term low-dose aspirin use on incident anemia and the effect of aspirin on changes in hemoglobin concentration, as well as ferritin levels, as an indicator of iron deficiency.

The researchers found that low-dose aspirin led to increased incident anemia in otherwise healthy older adults at enrollment, independent of major bleeding.

Previous ASPREE data analyses suggested daily low-dose aspirin does not decrease risk for dementia and cognitive decline; and that daily low-dose aspirin had no effect on healthy lifespan in older people.

ASPREE, a joint U.S. and Australian research project aimed at determining the effect of low-dose aspirin on survival without dementia or disability, began in 2010 and completed recruitment in 2014.

It was a randomized, double-blind, placebo-controlled, primary prevention trial of daily 100 mg of aspirin in a population of healthy older people in the U.S. and Australia with a period of treatment averaging 4.5 years.

The trial involving 19,114 people age 65 and older was distinctive for its size, methodological rigor, and high participant retention rate in both countries.

—By National Institute on Aging

Testosterone therapy doesn’t boost heart risk

Testosterone replacement therapy is safe for men with “low T” who have heart disease or are at high risk for it, a new study suggests.

But doctors warn the popular treatment is no “anti-aging tonic.”

The research, published last month in the New England Journal of Medicine, found that heart attacks, strokes and other major cardiac issues were no more common among those using testosterone gel than those using a placebo.

That implies the gel is also safe for men without cardiovascular problems who have low T, said Dr. Steven Nissen, a cardiologist at the Cleveland Clinic and senior author of the study.

But, he added, it doesn’t mean the treatment should be used by men without low T — a condition also known as hypogonadism that’s measured by levels of the sex hormone in the blood.

“What we’ve shown here is that for a very specific group of men, testosterone can be given safely,” Nissen said. “But it is not to be given as an anti-aging tonic for widespread use in men who are aging.”

More than 5,000 men ages 45 to 80 at 316 trial sites throughout the U.S. were randomly assigned to get the testosterone gel or the placebo, which they rubbed on their skin daily for an average of about 22 months. “Major cardiac events” occurred in 182 patients in the testosterone group and 190 patients in the placebo group.

The testosterone group did have a higher incidence of less severe problems, such as atrial fibrillation, acute kidney injury and issues from blood clots in veins.

The large study helps address “a gap of understanding” about how testosterone treatment affects cardiovascular outcomes for men with true low T, said Dr. Alan Baik, a cardiologist at the University of California-San Francisco who was not involved in the research.

But he’d like to see more research, he said, on whether testosterone therapy can actually reduce cardiovascular risk factors in men with low T, who seem more likely to have conditions like high blood pressure and diabetes.

Not an anti-aging treatment

Treating low T has been a big business for many years, largely driven by advertisements for pills, patches, gels and injections. Online sites and clinics across the nation offer the treatment, and many tie low T to common issues such as fatigue and weight gain.

The new study, led by the Cleveland Clinic and funded by a consortium of drug companies, was done in response to a 2015 mandate by the Food and Drug Administration for makers of testosterone products to carefully examine the risk of heart attack or stroke. A previous FDA review had shown that many men got low T treatment even though their testosterone levels hadn’t been checked.

Nissen said while low T is a “very common disorder,” aging men also want to feel like they’re 18 again and ‘’have the sexual performance they had when they were young,” he said.

But the treatment, he added, “should not be used by bodybuilders. It should not be used by athletes. The concerns about the misuse of testosterone are quite high. And I think we have to be very cautious.”

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