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@FayettevillePD/Twitter(WILMINGTON, N.C.) -- North Carolina's governor on Tuesday pleaded with residents to remain in shelters until flooding from Florence recedes.

"I know it was hard to leave home, and it's even harder to wait and wonder whether you have a home to go back to," Gov. Roy Cooper said at a news conference. "But please, for your safety ... do not try to return home yet."

Roads remain dangerous and creeks and rivers continue to rise, he added.

About 10,000 people are still in shelters and over 4,000 people have been rescued since the deadly storm made landfall on Friday.

In North Carolina, more than 1,000 roads remain closed, drenched by the powerful storm.

In South Carolina, one bridge was so weak that it gave out under a semi-truck Monday.

Getting food to people stranded by rising waters is also a problem.

"We have no way of getting food for ourselves or the animals," one trapped resident told ABC News. "Power is not gonna come back for awhile. Our road is washed out."

On Tuesday, Officials in Wilmington distributed goods including food, water and tarps to residents who lined up in cars and on foot.

Among those in line were Robert and Karen Foster, whose ceiling collapsed during the storm. The couple has already lived through hurricanes Floyd and Matthew.

"Everybody's closed, so we're hoping we can at least get a tarp here, maybe two," Karen Foster said.

"This has been the absolute worst one," she added. "And it's because it just sat over us for so long and dropped so much water."

Four mass feeding kitchens are operating across the state, and more are expected to be established, officials said Tuesday.

More crews are now assigned to debris removal and some ports will be open Wednesday for ferries to deliver needed supplies, officials added.

At least 32 people are dead, including several young children, as a result of the storm, which brought unprecedented rainfall and flooding to the Carolinas.

Florence dropped about 8.04 trillion gallons of rain on North Carolina, the National Weather Service said Tuesday, citing "the unofficial, radar-estimated storm total rainfall."

Rainfall totals in North Carolina and South Carolina have set new records from a tropical cyclone, with 35 inches and 23 inches respectively.

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Level Airlines(NEW YORK) -- When Erin Levi booked a $179 one-way flight to Paris on Level airlines for a friend's wedding a few weeks ago, she joked that it was too good to be true. It was.

When the travel writer arrived at Newark Airport on Sept. 9, she couldn't find her gate -- it was as if her flight didn’t exist.

Levi, 35, had entered her information into the airline's website to check in hours earlier. She had run into an error message while trying to choose a seat but otherwise hadn't noticed anything unusual. Unbeknownst to her, Level's launch of its Newark to Paris service had been delayed until Sept. 18, information that never appeared on the company's website.

"My flight doesn't exist!" she texted her friends from the airport. "Airline hasn't started transatlantic operations apparently!"

At the airport, Levi couldn't find a counter or an agent for Level, so she double-checked her ticket. It read "OpenSkies," a boutique airline operated by British Airways. So she headed to their counter. It was there, she said, she was told Level had delayed launching the Newark to Paris route and was given a number to call.

By that point, though, it was past midnight, and no one was answering the airline's hotline. So Levi bought a new ticket on Wow airlines, hoping to be reimbursed for the $319.98 she paid for the last-minute seat.

"I've traveled to over 40 countries -- even on a handwritten ticket to Uzbekistan -- and this has never happened before," Levi told ABC News.

A 'prudent decision' to postpone flights

But Levi is far from alone. Some Level customers said they never received emails saying that their flights had been canceled, or found out only upon arriving at the airport and being handed a sheet of paper. Others received emails that went to junk mail. Almost everyone ABC News spoke to said the company should have updated their website to reflect the change in business plans or cancellations.

Level is owned by International Airlines Group, the European parent company of British Airways, Aer Lingus and Iberia Airlines. It is among the latest low-cost, long-haul carriers to begin offering transatlantic flights, joining a market served by companies including Wow, Primera Air, XL Airways, Norwegian and Air France subsidiary Joon. As these discount airlines have fought to compete amid widespread industry consolidation, corners have been cut -- and customers are often the ones who are most impacted.

To its credit, Level has been forthright about its recent mistakes.

"Indeed, on August 20th, we took the prudent decision to postpone by two weeks the launch of our operations between Paris and New York, planned for September 4th, for operational reasons," Hugo Trac, Level’s communications and marketing manager, wrote in an email to ABC News. "Customers impacted by this launch delay have been alerted by email, sent to [the] address registered in their booking (or to the travel agency that did the booking)."

"We sincerely apologise for the inconvenience caused and delay to our passengers’ travel plans,” Trac said, adding that the airline is offering a full refund for tickets and rebooking on an alternative flights for alternative dates.

But sometimes, alternative dates aren't possible: Levi was heading to Europe for a wedding and needed to be there. She said that although she had received a confirmation email from the airline when she booked her flight, she never received an email about the cancellation. Other customers told ABC News they also showed up at the airport to find their flights were canceled. Some passengers said they did receive cancellation messages before setting off for their flights, but the notices were still so last minute they had to abruptly change vacation plans and spend much more than they'd budgeted.

'A stupid reason not to pay'

Florian Duval received an email 15 days before his trip from Paris to New York that his flight had been canceled -- but the email went to junk mail, so he didn’t see it right away. He bought a last-minute XL Airways round-trip flight for 345 Euros, about $403, roughly $134 more than his original ticket.

Duval said he was struck by the confusion of his fellow passengers as they fought to get their tickets refunded.

"Seeing that many people are affected by cancellations, and we are very poorly informed, I decided to create the Facebook group. And, above all, recommend everyone around me to never ever fly with Iberia-Level!" he said.

The closed group Vols annulés Septembre [Canceled flights September] 2018 [Iberia via Level via OpenSkies] had 50 members as of Monday who said they were trying to get refunds from the company for their botched flights. Duval recently got a refund for his flight.

Other passengers have united on social media, too. Passengers from canceled flights on Level's Montreal to Paris route have been extremely active and formed two Facebook groups: LEVEL vol annulé du 06/08 [Level canceled flights of June 8], which has more than a hundred members, and Level vol annulé 16 juillet 2018 [Level canceled flights July 16], which has nearly 200 members.

Neela Parsnani said her Level flight from Montreal to Paris was canceled after passengers boarded for an hour. The passengers were shuttled to a hotel and promised dinner, but the restaurant was out of food, and her children went to bed after eating peanuts from the bar. Parsnani said she wasted vacation days sorting out re-routed flights and was forced to fork out for last-minute tickets from Montreal, cabs, meals and other expenses.

When she went to get her refund from Level, she said she was asked to send several rounds of documentation to the company and jump through other hoops.

"There's always a stupid reason not to pay us. At one point, I had to send my children's birth certificates. The communication with them is awful. They're amateurs," Parsnani told ABC News.

Parsnani is now on a WhatsApp chat group with about 100 members from her canceled flight who share tips on getting refunds, she said.

Confusion over who to call

Similarly, Level's inaugural Martinique-Paris service was also delayed.

"For same reasons as Newark, our operations to Martinique have been postponed, too," Trac wrote in his email to ABC. "First flight to/from Martinique was originally planned on September 3rd. It will now starts on October 1st."

Yet as of Tuesday, the website said flights to and from Martinique would launch in September.

Part of the problem echoed throughout the Facebook groups and interviews with more than a dozen stranded passengers is that the different operating companies add to the confusion. Some people booked their tickets on the Iberia Airlines website, some booked through Level's site and some booked through third-party sites like Expedia. Others passengers' tickets were issued through OpenSkies.

But Level maintains that it has notified customers.

"We applied the same process in terms of passengers' option[s] for both Newark and Martinique. An email has been sent to [the] passenger's email address filed in the booking details (or email [for] travel agencies if booking [was] done by them, as they are in charge of advising their clients). In communications sent to clients, [it] was mentioned that customers who purchased through a travel agency should claim a refund through the agency directly; customers who purchased through should contact Iberia for a refund and customers who purchased on claim a refund from Level directly," Trac wrote. "Our customer service is dealing with each request and every client will get an answer from our service."

When asked whether Level had been overly ambitious and launched transatlantic service before it was ready, Trac wrote: "We offer transatlantic service with Level from Paris to Montreal and Guadeloupe since July 2nd. We needed to ensure the robustness of our schedule before we launch these additional routes (Martinique and Newark), which is why we took the prudent decision to delay their start."

'Desperate to find a way home'

Pablo Ferreiro-Mazón, an architect from Galicia, Spain, learned this the hard way. He was already on vacation with his wife and son in the Caribbean. The family planned to island hop, so he booked an Aug. 17 Level flight from Paris to Guadeloupe, a route launched by Level in July. They booked a return to Paris from Martinique, Level’s new route, for Sept. 3. On Aug. 21, he received an email from the airline stating that their flights were canceled.

With spotty cell phone service in Guadeloupe, he tried calling Iberia -- an airline he said he's flown his entire life and has some status with -- several times, which proved difficult and expensive. There was no direct number provided for a refund or alternate plans, he said, so he kept trying, with calls often costing 30 or 40 Euros each. After several days, Ferreiro-Mazón said, he got through to an agent who told them the Martinique service launch had been delayed and offered to rebook them for Sept. 23.

"You cannot tell a family you have to stay there another 20 days," Ferreiro-Mazón, 53, said. Aside from the cost of the hotel, he and his wife, a doctor, had to go back to work and his son had to get back for medical school. "As you can imagine, we were quite desperate to find a way home."

The family finally paid 401 Euros, about $466, to fly another airline back to Guadeloupe to catch the Level flight to Paris on Sept. 2. That meant cutting short their stay in the Caribbean, and sacrificing their pre-paid hotel and car rental. In addition, they flew back to Paris a day earlier and had to spend extra on a hotel room there before making their flight back to Spain, he said.

But Ferreiro-Mazón said it's not about the money.

"For a week, we were very worried about this situation," he said. "I don't know how to value that. You are on holiday, moving from one island to another. You are worried and you should not be worried about this on holiday."

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Subscribe To This Feed -- President Donald Trump on Tuesday said the allegation against his embattled Supreme Court nominee Brett Kavanaugh should go through a process.

There “there shouldn't even be a little doubt,” Trump said of the process.

“Hopefully the woman will come forward, state her case,” Trump said Tuesday. “He will state his case before representatives of the United States Senate. And then they will vote, they will look at his career, they will look at what she had to say from 36 years ago, and we will see what happens.”

And as he did earlier in the day, Trump said he didn't think the FBI should be involved, despite Democrats' insistence that, before any public hearing with the nominee and his accuser, the FBI should look into an allegation made by professor Christine Blasey Ford, 51, that Kavanaugh sexually assaulted her when they were both in high school decades ago in suburban Maryland.

Kavanaugh, who was back at the White House on Tuesday for the second day in a row, has repeatedly denied the alleged encounter ever happened.

The president said he has not personally spoken with Kavanaugh since the allegation surfaced, saying “specifically I thought it would be a good thing not to.”

Trump pointed out that Kavanaugh has had multiple background checks throughout his career and called his history "impeccable."

"I feel so badly for him that he is going through this," Trump said during a press conference on Tuesday afternoon with Polish President Andrzej Duda.

The sexual assault allegation became public after the contents of a letter Ford sent to California Sen. Dianne Feinstein, a member of the Senate Judiciary Committee, were disclosed to several media outlets.

Asked if he believes the allegation is political in nature, the president said: “I don't want to say that. Maybe I will say that in a couple of days, but not now,” Trump said earlier on Tuesday.

Trump, however, attacked Democrats for “holding” onto the allegation, saying it was “a terrible thing that took place” when the story surfaced over the weekend.

“It's a terrible thing that took place and it's frankly a terrible thing that this information was not given to us months ago when they got it,” Trump said.

Meanwhile, Senate Majority Leader Mitch McConnell is pushing ahead with plans to hear testimony from Kavanaugh and Ford on Monday.

This, despite the numerous calls from Democrats to slow down the process and allow the FBI to re-open its background investigation into Kavanaugh so that they can determine the facts of what happened to Ford in high school, when she alleges Kavanaugh forced himself on her.

"She's been asking for the opportunity to be heard and she's being given the opportunity to be heard on Monday," McConnell told reporters.

"She could do it privately if she prefers or publicly if she prefers. Monday is her opportunity," he said.

Democrats have been writing to White House Counsel Don McGahn and to Judiciary Chairman Chuck Grassley to request the FBI re-open its investigation into Kavanaugh but to no avail.

Democrats are also crying foul over Grassley's decision to not allow other witnesses besides Kavanaugh and Ford to testify.

Grassley has said Ford has still not accepted his invitation to appear before the Judiciary Committee on Monday.

However, McConnell and GOP leadership are forging ahead with the hearing.

"There have been multiple investigations. Judge Kavanaugh has been through six investigations in the course of his lengthy public career. We want to give the accuser the opportunity to be heard and that opportunity will occur next Monday," McConnell reiterated.

"I think that gives her ample opportunity to express her point of view and Judge Kavanaugh of course has been anxious for days to discuss the matter as well," McConnell said.

This is a developing story. Please refresh for details.

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iStock/Thinkstock(BERLIN) -- Petya Verzilov, a member of the Russian protest group Pussy Riot, has likely been poisoned, doctors treating him in Germany said Tuesday.

Verzilov, one of the early members of the group that has for years staged provocative demonstrations against Russia's government, was rushed to a hospital last week in Moscow after he suddenly began suffering vision and motion loss and fell unconscious. His relatives and fellow activists quickly suspected Verzilov was the victim of poisoning and on Tuesday doctors at the Berlin hospital where he has been transferred for treatment said they had no other explanation for his sudden sickness.

"The impression and the findings that we now have, as well as those provided by colleagues from Moscow, suggest that it was highly plausible that it was a case of poisoning,” Dr. Kai-Uwe Eckardt of Berlin's Charite hospital told reporters.

Eckardt said doctors currently have "no evidence whatsoever that there would be another explanation for his condition.”

The hospital’s chairman, Karl Max Einhaeupl, told reporters that Verzilov was no longer in life-threatening danger and that his condition was “improving day by day.”

Verzilov, 30, fell sick following a friend's court hearing in Moscow on Sept. 11 and was taken by ambulance to hospital, where he was placed in intensive care. Verzilov's symptoms included disorientation and widened pupils and Russian doctors began treating him for possible poisoning, Eckardt said, emptying his stomach and performing a dialysis.

Verzilov, who has Russian and Canadian citizenship, was then moved to Germany by air ambulance on Saturday, flown there by the Cinema for Peace Foundation, an NGO that has supported Pussy Riot.

Eckardt said Verzilov was suffering from anticholinergic syndrome, which can disrupt the nervous system.

He said that laboratory tests were currently being carried out to identify the exact substance used to poison Verzilov but said it was unlikely that would be possible given the amount of time that had passed since he was exposed.

Eckardt ruled out that Verzilov could have taken the drug himself, saying there was “no evidence that there is a drug problem” and that it would be highly unusual for someone to take the drug in such a high dose unless the person was suicidal, which he said they had “no indications of.”

Eckardt said he hoped Verzilov would now make a full recovery and would not suffer any long-term health consequences.

Verzilov is one of the best-known members of Pussy Riot and is the estranged husband of Nadya Tolokonnikova, whose arrest in 2012 with two other activists over their protest in a Moscow cathedral led to the group becoming world famous. During that period Verzilov, a veteran activist and provocateur, became a kind of impresario for the group, often handling media inquiries.

In recent years, he has continued to arrange stunts targeting president Vladimir Putin's rule even as Tolokonnikova and the group's other leading member, Maria Alekhina, have increasingly stopped performing together. In July, Verzilov and two other Pussy Riot members were sentenced to 15 days jail for a demonstration during the World Cup final, in which they ran onto the field dressed as police officers to protest police oppression in Russia.

There have been a number of high profile poisoning cases involving opponents of the Russian government recently, including the poisoning of former spy Sergey Skripal and his daughter.

Another prominent activist, Vladimir Kara-Murza, from the liberal group Open Russia, in 2015 and 2017 was poisoned twice with an unknown substance. Kara-Murza suffered organ failure on both occasions and now walks with a cane. Despite extensive tests, doctors were unable to identify the poison.

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Iowa State Department of Athletics(AMES, Iowa) -- A man with a criminal background was charged with murder just hours after a former Iowa State University champion golfer turned up dead in a pond on a golf course.

Collin Daniel Richards, 22, who police said has no known address and, according to court records, was kicked out of the grandparents' house a year ago, was charged with first-degree murder in Celia Barquin Arozamena's stabbing death Monday.

Police found her body at Coldwater Links golf course near Iowa State University in Ames, where she apparently went golfing alone Monday morning.

Richards purportedly made statements to an acquaintance recently "to the effect of having an urge to rape and kill a woman," according to a criminal complaint made public Tuesday.

Story County Attorney Jessica Reynolds described the killing as "a random act of violence" during a brief court hearing for Richards Tuesday morning.

"The state believes him to be a flight risk, also believes him to be a danger to the community," Reynolds said during the hearing.

The judge granted her request to set bail at $5 million.

Richards appeared in court in shackles and made no statements. He was ordered to return to court Sept. 28 for a preliminary hearing.

Attorney Paul Rounds of the Story County Public Defender's Office was appointed to represent Richards.

"I hope people reserve judgment until after the trial," Rounds told ABC News when reached by phone, declining to comment further

Cmdr. Geoff Huff, head of the Ames Police Department's criminal investigations division, said at a news conference Tuesday, "It's rare, obviously. It's still very troubling that something like this would happen in broad daylight in a community that is as safe as Ames is.”

He added: "It's an awful thing that's happened. I'm not sure what else I can say."

Barquin Arozamena, a native of Spain, was recently named Iowa State’s female athlete of the year.

Barquin Arozamena had turned pro this past spring after completing her college golfing career. Earlier this year, she qualified for the U.S. Women's Open in Alabama, one of the LPGA Tour's majors.

The Ames Police Department opened a suspicious death investigation Monday morning when golfers found Barquin Arozamena's cellphone, ball cap and golf bag on the ninth hole fairway of the golf course "with no one around it," according to a police statement.

Golfers had seen Barquin Arozamena on the golf course earlier but told police she had disappeared, prompting a search for her, officials said.

Officers were called to the golf course about 10:24 a.m. and found Barquin's body a half-hour later in a pond near where her golf bag was discovered and determined she had been assaulted, according to the criminal complaint.

"Based on the scene investigation, the victim sustained several stab wounds to the upper torso, head, and neck," the criminal complaint stated.

Police searched the golf course and stopped a man walking on a trail leading into a wooded area who identified himself as an acquaintance of Richards.

A K-9 unit tracked the victim's scent to a homeless encampment on the banks of Squaw Creek in the wooded area adjacent to the golf course, according to the criminal complaint.

Police were searching the camp, which consisted of two tents, when Richards approached them.

"Officers observed the … [Richards] had several fresh scratches on his face consistent with fighting, and also noted [he] attempted to conceal a deep laceration to his left hand, which he attempted to bury in the ground," the criminal complaint reads.

Police also contacted an acquaintance of Richards who told them the suspect showed up at his residence near the golf course Monday afternoon and that he "appeared disheveled and covered in blood, sand and water," according to the complaint.

The man told police Richards left his house after bathing and washing his clothes, the complaint stated.

Two other witnesses told police that Richards asked them for a ride to Jefferson, Iowa, and had given them a knife, according to the complaint. While driving to Jefferson, Richards told the men he needed to return to the homeless encampment because he forgot his tent, according to the complaint.

When they arrived at the golf course, they noticed police swarming the area, the complaint says. Richards got out of their vehicle and approached police officers searching the tent encampment, the complaint states.

Police said they recovered a knife that Richards allegedly gave to two witnesses, according to the complaint. Police also found two pairs of blood-stained shorts in Richards' backpack.

Several law enforcement agencies, including the Iowa State University Police Department, assisted in the investigation.

"I don't know a lot of the details yet but it's just a horrific, horrific senseless death," Iowa Gov. Kim Reynolds told reporters Tuesday at the Iowa Capitol in Des Moines.

Reynolds' statement was echoed by Iowa State University President Wendy Wintersteen.

"We were deeply saddened to learn yesterday of the death of Celia Barquin Arozamena. Celia was a dedicated student in civil engineering. She was a talented student athlete and an acclaimed golfer with a bright future," Wintersteen said in a statement Monday. "Celia was a champion and a proud ambassador for Iowa State. Our hearts are with Celia's family and friends as we grieve her passing. It's a terrible, tragic and senseless loss.

"In these moments, we recognize our own mortality and realize that each day is a gift," Wintersteen said. "I hope everyone will take time today to meet with their friends and loved ones, value those connections and feel thankful that they can do so. A bright candle in our Cyclone Nation no longer shines, and our community and the world are less for it."

Barquin Arozamena claimed the 2018 Big 12 Championship with a three-shot victory in April, according to the university, which called her one of the most accomplished golfers in the school’s history. She was finishing her civil engineering degree this semester.

The death of Barquin Arozamena prompted the Iowa State women's golf team to withdraw from competition at the East and West Match Play tournament in Ann Arbor, Michigan, to return to Iowa to mourn the former teammate, the team said in a tweet.

The team was scheduled Tuesday to play for the tournament title.

"We are all devastated," Christie Martens, Iowa State head women's golf coach, said in a statement. "Celia was a beautiful person who was loved by all her teammates and friends. She loved Iowa State and was an outstanding representative for our school. We will never forget her competitive drive to be the best and her passion for life."

Iowa State Director of Athletics Jamie Pollard added: "Celia had an infectious smile, a bubbly personality and anyone fortunate enough to know her was blessed. Our Cyclone family mourns the tragic loss of Celia, a spectacular student-athlete and ISU ambassador."

Barquin Arozamena qualified for the U.S. Women's Open golf tournament in Shoal Creek, Alabama, in May but did not make the cut after the first two rounds.

The university’s Athletics Department said it plans to honor her memory at a football game Saturday at the school's Jack Trice Stadium, which is across the street from where police found her body.

Funeral arrangements are pending.

"I'm just kind of surprised," ISU freshman Isaac Sachse told Iowa ABC Des Moines affiliate.

"First it was the kidnapping and now this. It's kind of horrifying," he added, referring to the death of University of Iowa student Mollie Tibbetts earlier this summer.

Richards has a criminal record, according to court documents. He has pleaded guilty to charges of domestic abuse, assault, theft and public intoxication in the past, the records show.

In September 2017, he was arrested on suspicion of breaking into his grandparents' house, according to court records. Richards told police he had broken into the house to retrieve his belongings after his grandparents had kicked him out, records show.

Richards’ most recent arrest occurred in July when he was taken into custody on suspicion of public intoxication after police found him passed out at a convenience store in Ames, according to records.

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NBC/Paul Drinkwater(LOS ANGELES) -- Just a few days after Katt Williams belittled Tiffany Haddish's celebrity and meteoric rise as a comedian, the two comedians appear to have reconciled.

In an Instagram post on Monday night, Haddish posted several photos with Williams, who was seen bowing down to her backstage at the Emmys. The two had won Emmys the weekend before, Haddish  for Guest Actress in a Comedy Series for hosting Saturday Night Live and Williams for Guest Actor in a Comedy Series for his role in Atlanta.

“#Emmys2018 #Success #Winners,” the Girls Trip actress captioned the photo.

As previously reported, Williams had dismissed Haddish's success in a recent radio interview, saying she hadn't hadn't put in enough work as a comedian to earn the kinds of opportunities she's received.  He also incorrectly accused her of not ever having her own comedy special.

In response to his criticism, Haddish had a classy comeback to his snarky remarks.

“It’s official I made it! [Katt Williams] talked about me and didn’t have his facts right!” she tweeted. “I look forward to seeing you on Monday, Katt, when we pick up our Emmys. I just want to shower you with REAL love cause you need it, and I love you.”

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iStock/ThinkstockBY: DR. NICKY MEHTANI

(NEW YORK) -- A daily aspirin may have more risks than benefits if you’re over 70, according to a new study published this week in the New England Journal of Medicine. Yet aspirin, called a “wonder drug” against heart disease, is taken regularly by about 50 percent of adults nationwide.

The clinical trial, called ASPREE -- Aspirin in Reducing Events in the Elderly – was conducted by researchers at Monash University in Melbourne, Australia and studied healthy elderly adults who took a low dose (100 mg) of aspirin daily over a nearly five year period.

What did the study find?

Aspirin, known to help fight heart disease in those at risk, did NOT improve life expectancy free from dementia or disability for healthy adults over 69. The rate of death, dementia, or development of a persistent physical disability (lasting over 6 months) was the same among people who took aspirin and those taking a placebo pill.

Aspirin, like any medicine, has side effects, and can cause an increased risk of bleeding in the digestive tract and brain. The people who were taking aspirin in this study had a 3.8 percent chance of bleeding; those who weren’t taking it had a 2.8 percent chance of bleeding.

The most concerning consequence in healthy adults over 69 was an increased risk of death, including deaths due to cancer. The risk of death, from any cause, was 5.9 percent in the aspirin group and 5.2 percent in the placebo group. Cancer was the major contributor to the higher mortality rate: 3.1 percent of people taking aspirin died of cancer compared to only 2.3 percent people not taking it.

What do they mean by “healthy elderly adults”?

ASPREE looked at the effects of daily low-dose aspirin in “healthy” older adults who had no known history of heart disease, strokes, dementia, or other significant chronic illnesses. All Caucasians were 70 or older and Black and Latino people were 65 and older.

Most of our current knowledge on aspirin’s efficacy has come from studies on people who had heart problems -- a history of heart attacks, strokes, or other cardiovascular diseases. In this sicker population, studies are clear: aspirin helps decrease mortality rates, prevent heart attacks and strokes, and reduce the risk of colorectal cancer.

An important note: this study does NOT suggest that people should stop taking aspirin if they’ve had a history of heart disease. But the results do mean that doctors may re-think aspirin’s role in the prevention of heart disease.

How good is the new evidence?

In short, the new evidence is quite strong. The ASPREE trial was large, including more than 19,000 people from 34 places in the U.S. and 16 places in Australia. It was a randomized clinical trial (RCT), the most reliable type of research -- half of the people involved were randomly assigned to take low-dose aspirin daily and the other half was given a daily placebo, a pill that looks identical to aspirin but does not contain the active ingredient. People in the study had no way of knowing whether or not they were taking the active drug, nor did the doctors who gave them the pills. Large RCTs such as this one are widely regarded in the scientific community as the most useful in helping understand the effects of medications.

But there is a lot that this study did NOT tell us. The authors caution that since the increased death rate in the group taking aspirin was so small, it could have been a coincidence. Aspirin has been widely studied, and this negative effect goes against the results of many prior large studies. In addition, 91 percent of the people in the study were Caucasian, so the effects on Black and Hispanic people are harder to interpret.

The trial was also relatively short. The researchers followed people for about four and a half years. That’s not much time to detect potential effects of aspirin on conditions like Alzheimer’s and cancer, which take a long time to develop before they’re recognized and treated.

What are the current aspirin guidelines? Will they change?

The most recent U.S. Preventive Services Task Force guidelines say there is “insufficient” evidence in regards to the benefits and harms of starting aspirin for people over the age of 69 who have no prior history of significant heart disease or strokes. For those between 60 and 69, the decision to start low-dose aspirin should be discussed by each patient with their doctor, and it will depend on their risk of bleeding and other factors. For people between the ages of 50 and 59 who have heart disease risk, daily low-dose aspirin is generally recommended.

Those guidelines won’t necessarily change. But the new research findings suggest that, among healthy adults over age 69, there might be enough evidence now to recommend against starting low-dose aspirin.

Does this mean I should stop taking aspirin?

No. Remember, this new research only applies to a small subset of the people who take aspirin daily. Medicine is applied one patient at a time, and guidelines are only guidelines: they don’t apply to everyone. Speak to your doctor before making any decisions regarding whether you should start or stop taking aspirin.

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