Logo image
Back
Effect of Aspirin on All-Cause Mortality in the Healthy Elderly
Journal article   Open access   Peer reviewed

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

John J McNeil, Mark R Nelson, Robyn L Woods, Jessica E Lockery, Rory Wolfe, Christopher M Reid, Brenda Kirpach, Raj C Shah, Diane G Ives, Elsdon Storey, …
The New England journal of medicine, Vol.379(16), pp.1519-1528
10/18/2018
DOI: 10.1056/NEJMoa1803955
PMCID: PMC6433466
PMID: 30221595
url
https://doi.org/10.1056/NEJMoa1803955View
Published (Version of record) Open Access

Abstract

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. 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. 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). 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 .).
 Australia United States Administration, Oral Aged Aged, 80 and over Aspirin - adverse effects Aspirin - therapeutic use Cause of Death Female Follow-Up Studies Hemorrhage - chemically induced Hemorrhage - mortality Humans Independent Living Male Mortality Neoplasms - mortality Platelet Aggregation Inhibitors - adverse effects Platelet Aggregation Inhibitors - therapeutic use Treatment Failure

Details

Metrics

27 Record Views
650 Times Cited - Web of Science
Logo image