‘ASPREE’ finds non-CVD patients derive little benefit from daily aspirin
A daily, low dose of aspirin isn’t preventive against early death or disability in older patients who are otherwise healthy, according to results from the eight-year ASPREE trial that were released Sept. 16.
The work, published as a three-part series in the New England Journal of Medicine, found seniors with no history of dementia or physical disability and no indication for aspirin use derived little benefit from a daily 100-milligram aspirin tablet—something that’s been proven to mitigate risk for cardiovascular disease and stroke.
“Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease,” Richard J. Hodes, MD, said in a press release. Hodes is the director of the National Institute of Aging, which, alongside the National Cancer Institute and Australian National Health and Medical Research Council, helped fund the study. “The concern has been uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions.”
That’s why it’s important to conduct this type of research, Hodes said, “so that we can gain a fuller picture of aspirin’s benefits and risks.”
For the trial—a randomized, double-blind, placebo-controlled study that enrolled 16,703 Australians and 2,411 Americans—participants were randomized to either 100 milligrams of low-dose aspirin per day or a placebo, and followed for an average of five years. By the time the study concluded, nearly 10 percent of both patient groups had died.
Patients who took aspirin had an increased risk of death compared to the placebo group, according to the results. While 5.9 percent of participants taking aspirin died during the trial, that number was 5.2 percent in the placebo group—something the researchers said could be attributed to a higher rate of cancer cases in the aspirin group.
Rates for major cardiovascular events were similar between groups, including in regard to coronary heart disease, nonfatal myocardial infarction and ischemic stroke. Clinically significant bleeding, though, such as hemorrhagic stroke and gastrointestinal bleeding, saw 3.8 percent prevalence in the aspirin cohort, compared to 2.7 percent in the placebo group. The former group was most at risk for major bleeding in their gastrointestinal tracts and brains.
“Continuing follow-up of the ASPREE participants is crucial, particularly since longer-term effects on risks for outcomes such as cancer and dementia may differ from those during the study to date,” Evan Hadley, MD, director of the NIA’s Division of Geriatrics and Clinical Gerontology, said in the release. “The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants.”
After graduating from Indiana University-Bloomington with a bachelor’s in journalism, Anicka joined TriMed’s Chicago team in 2017 covering cardiology. Close to her heart is long-form journalism, Pilot G-2 pens, dark chocolate and her dog Harper Lee.