McNeil, JJ and Nelson, MR and Woods, RL and Lockery, JE and Wolfe, R and Reid, CM and Kirpach, B and Shah, RC and Ives, DG and Storey, E and Ryan, J and Tonkin, AM and Newman, AB and Williamson, JD and Margolis, KL and Ernst, ME and Abhayaratna, WP and Stocks, N and Fitzgerald, SM and Orchard, SG and Trevaks, RE and Beilin, LJ and Donnan, GA and Gibbs, P and Johnston, CI and Radziszewska, B and Grimm, R and Murray, AM, for the ASPREE Investigator Group, Effect of aspirin on all-cause mortality in the healthy elderly, New England Journal of Medicine, 379, (16) pp. 1519-1528. ISSN 0028-4793 (2018) [Refereed Article]
Copyright 2018 Massachusetts Medical Society
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.
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).
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.
|Item Type:||Refereed Article|
|Keywords:||aspirin, mortality, healthy elderly|
|Research Division:||Biomedical and Clinical Sciences|
|Research Group:||Cardiovascular medicine and haematology|
|Research Field:||Cardiology (incl. cardiovascular diseases)|
|Objective Group:||Clinical health|
|Objective Field:||Clinical health not elsewhere classified|
|UTAS Author:||Nelson, MR (Professor Mark Nelson)|
|Web of Science® Times Cited:||293|
|Deposited By:||Menzies Institute for Medical Research|
|Downloads:||54 View Download Statistics|
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