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

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McNeil, JJ, Nelson, MR ORCID: 0000-0001-9941-7161, 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 and Murray, AM 2018 , 'Effect of aspirin on all-cause mortality in the healthy elderly' , New England Journal of Medicine, no. 16 Sep , pp. 1-10 , doi: 10.1056/NEJMoa1803955.

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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 Type: Article
Authors/Creators: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
Journal or Publication Title: New England Journal of Medicine
Publisher: Massachusetts Medical Soc/Nejm
ISSN: 0028-4793
DOI / ID Number: 10.1056/NEJMoa1803955
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Copyright 2018 Massachusetts Medical Society

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