Effect of aspirin on all-cause mortality in the healthy elderly

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; for the ASPREE Investigator Group

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Effect of aspirin on all-cause mortality in the healthy elderly

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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]

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DOI: doi:10.1056/NEJMoa1803955

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.

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 Details

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 Division:	Health
Objective Group:	Clinical health
Objective Field:	Clinical health not elsewhere classified
UTAS Author:	Nelson, MR (Professor Mark Nelson)
ID Code:	128491
Year Published:	2018
Web of Science^® Times Cited:	433
Deposited By:	Menzies Institute for Medical Research
Deposited On:	2018-09-25
Last Modified:	2022-08-25
Downloads:	77 View Download Statistics

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