Daily low-dose aspirin was not associated with a reduced risk for cardiovascular disease (CVD) when used as a primary prevention strategy and was in fact linked with an increased risk for major hemorrhage, new results from the Aspirin in Reducing Events in the Elderly (ASPREE) study suggested.
The authors, publishing a series of aspirin studies in the New England Journal of Medicine, included an analysis of the long-term associated between daily aspirin use and cardiovascular risks, dementia, and physical disabilities. The cardiovascular analysis included 19,114 patients without cardiovascular disease, dementia, or physical disability, and randomized them to either 100 mg enteric-coated aspirin or to placebo. The primary endpoint was a composite of death, dementia, or persistent physical disability, which are reported in another NEJM article, but the study also included important secondary endpoints such as major hemorrhage and cardiovascular disease (defined as fatal coronary heart disease, nonfatal myocardial infarction, fatal or non-fatal stroke, or hospitalization for heart failure). The patients were followed for a mean of 4.7 years.
The study results showed a cardiovascular disease rate of 1.7 events per 1,000 person-years in the aspirin group compared to 11.3 events per 1,000 person-years in the placebo group (HR=0.95; 95% CI, 0.83 to 1.08). The rate of major hemorrhage, however, was elevated, at 8.6 events per 1,000 person-years in the aspirin group compared to 6.2 events per 1,000 person-years for placebo (HR=1.38; 95% CI, 1.18 to 1.62; P<0.001).
“This work is a key milestone in the more than a decade-long engagement in this large-scale clinical trial in the United States and Australia,” lead investigator Dr. Raj C. Shah, an associate professor of family medicine with the Rush Alzheimer’s Disease Center in Chicago, said in a press release. “The results will have a significant impact on guidelines about aspirin use for prevention and in daily clinical conversations between clinicians and their older, healthy patients regarding whether aspirin should or should not be used for achieving disability-free longevity.”
I'm very interested in ASPREE, but also confused why this is split across 3 separate @NEJM articles taking 30 print pages.
Anybody care to explain why? I have an idea but I'm just guessing.@bnallamo @boback @DavidLBrownMD @SVRaoMD @cmg @f2harrell @RogueRad @thebyrdlab
— Venk Murthy MD PhD (@venkmurthy) September 16, 2018
My take on the new aspirin studies @NEJM…may be time for older, healthy adults to toss their baby aspirin. Caused bleeds without benefit. Less is more. And also heralds the need for more of these types of study in older folks. https://t.co/5Uu5yn27e2 @forbeshealth @matthewherper pic.twitter.com/n38Y1nsbqo
— Harlan Krumholz (@hmkyale) September 17, 2018
3 studies show no benefits in HEALTHY ADULTS OVER 70 for low dose aspirin. BUT DON’T STOP YOUR ASPIRIN IF YOU HAVE HEART DISEASE OR STROKE OR STENT. Please read the details on these studies. @American_Heart @CDCgov @NIH @ACCinTouch @cnnhealth @NBCHealthyTV @CBSNews pic.twitter.com/pAeG1d2NrP
— Gina Lundberg MD FACC FAHA (@gina_lundberg) September 17, 2018
A series of articles in @nejm randomizing "healthy elderly" (>70yrs / n>19.000 /w/o CVD) to aspirin 100mg/d vs. placebo showed
– similar CVD events
– higher bleeding
– similar disability-free survival
– higher allcause mortality (!) in pats on aspirinhttps://t.co/m1aBivGDph pic.twitter.com/T6JtovJlUa— Konstantin Krychtiuk (@krychtiukmd) September 16, 2018
https://twitter.com/MarcDweck/status/1041641516102569984
Source: New England Journal of Medicine
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