Grand Rounds

Does Daily Aspirin Increase Death Rates in Healthy Older Adults?

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

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

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

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

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