BACKGROUND AND PURPOSE:

• Daily aspirin use in healthy older adults has been found to be related to increased all-cause mortality
• McNeil et al. (NEJM, 2018) went on to further assess the specific causes of death in the healthy elderly population

METHODS:

• Secondary analysis of randomized controlled trial (RCT)
  • Aspirin in Reducing Events in the Elderly (ASPREE) trial
• Participants: Individuals ≥70 years without cardiovascular disease, dementia, or disability
• Participants received either
  • 100 mg enteric-coated aspirin
  • Placebo
• Deaths were classified according to the underlying cause by adjudicators who were unaware of trial-group assignments

RESULTS:

• 9,525 people were randomized
  • 1052 deaths occurred during a median of 4.7 years of follow-up
• Risk of death from any cause
  • 12.7 events per 1000 person-years in the aspirin group
  • 11.1 events per 1000 person-years in the placebo group
  • Hazard ratio (HR) 1.14; 95% CI; 1.01 to 1.29
• Cancer was the major contributor
  • 3.1% of the aspirin group
  • 2.3% of the placebo group
  • HR 1.31; 95% CI, 1.10 to 1.56
  • 1.6 excess deaths per 1000 person-years
  • No single cancer location or pathologic type was observed

CONCLUSION:

• Aspirin lead to higher all-cause mortality in the elderly (≥70 years at enrollment) who did not have an indication for aspirin
• The deaths were attributable primarily to cancer, not increased bleeding
  • Based on CI, this increase ranges from 1 to 29% of all-cause mortality
• This result contradicts early studies and authors recommend interpreting the data with caution
  • This study is an RCT as opposed to many previous research studies which was based on meta-analyses
  • This study may have ended before a preventative benefit appeared

Learn More – Primary Sources:

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

Related ObG Topics:

Does Low-Dose Aspirin Reduce Risk of First Cardiovascular Events in Individuals at Moderate Risk?

Patient with Stable CVD: Rivaroxaban, Aspirin or Both to Prevent Recurrent Events?

Low Dose Aspirin and Breast Cancer Prevention – Results from the CTS Cohort