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Effect of Aspirin on All-Cause Mortality in the Healthy Elderly.

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly.

Authors :
McNeil JJ
Nelson MR
Woods RL
Lockery JE
Wolfe R
Reid CM
Kirpach B
Shah RC
Ives DG
Storey E
Ryan J
Tonkin AM
Newman AB
Williamson JD
Margolis KL
Ernst ME
Abhayaratna WP
Stocks N
Fitzgerald SM
Orchard SG
Trevaks RE
Beilin LJ
Donnan GA
Gibbs P
Johnston CI
Radziszewska B
Grimm R
Murray AM
Source :
The New England journal of medicine [N Engl J Med] 2018 Oct 18; Vol. 379 (16), pp. 1519-1528. Date of Electronic Publication: 2018 Sep 16.
Publication Year :
2018

Abstract

Background: In the primary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, now published in the Journal, we report that the daily use of aspirin did not provide a benefit with regard to the primary end point of disability-free survival among older adults. A numerically higher rate of the secondary end point of death from any cause was observed with aspirin than with placebo.<br />Methods: From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or ≥65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or disability. Participants were randomly assigned to receive 100 mg of enteric-coated aspirin or placebo. Deaths were classified according to the underlying cause by adjudicators who were unaware of trial-group assignments. Hazard ratios were calculated to compare mortality between the aspirin group and the placebo group, and post hoc exploratory analyses of specific causes of death were performed.<br />Results: Of the 19,114 persons who were enrolled, 9525 were assigned to receive aspirin and 9589 to receive placebo. A total of 1052 deaths occurred during a median of 4.7 years of follow-up. The risk of death from any cause was 12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group (hazard ratio, 1.14; 95% confidence interval [CI], 1.01 to 1.29). Cancer was the major contributor to the higher mortality in the aspirin group, accounting for 1.6 excess deaths per 1000 person-years. Cancer-related death occurred in 3.1% of the participants in the aspirin group and in 2.3% of those in the placebo group (hazard ratio, 1.31; 95% CI, 1.10 to 1.56).<br />Conclusions: Higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death. In the context of previous studies, this result was unexpected and should be interpreted with caution. (Funded by the National Institute on Aging and others; ASPREE ClinicalTrials.gov number, NCT01038583 .).

Details

Language :
English
ISSN :
1533-4406
Volume :
379
Issue :
16
Database :
MEDLINE
Journal :
The New England journal of medicine
Publication Type :
Academic Journal
Accession number :
30221595
Full Text :
https://doi.org/10.1056/NEJMoa1803955