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https://hdl.handle.net/2440/120005
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Type: | Journal article |
Title: | Effect of aspirin on all-cause mortality in the healthy elderly |
Author: | McNeil, J. Nelson, M. Woods, R. Lockery, J. Wolfe, R. Reid, C. Kirpach, B. Shah, R. Ives, D. Storey, E. Ryan, J. Tonkin, A. Newman, A. Williamson, J. Margolis, K. Ernst, M. Abhayaratna, W. Stocks, N. Fitzgerald, S. Orchard, S. et al. |
Citation: | New England Journal of Medicine, 2018; 379(16):1519-1528 |
Publisher: | Massachusetts Medical Society |
Issue Date: | 2018 |
ISSN: | 0028-4793 1533-4406 |
Statement of Responsibility: | J.J. McNeil, M.R. Nelson, R.L. Woods, J.E. Lockery, R. Wolfe, C.M. Reid, B. Kirpach, R.C. Shah, D.G. Ives, E. Storey, J. Ryan, A.M. Tonkin, A.B. Newman, J.D. Williamson, K.L. Margolis, M.E. Ernst, W.P. Abhayaratna, N. Stocks, S.M. Fitzgerald, S.G. Orchard, R.E. Trevaks, L.J. Beilin, G.A. Donnan, P. Gibbs, C.I. Johnston, B. Radziszewska, R. Grimm, and A.M. Murray [for the ASPREE Investigator Group] |
Abstract: | Background: 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. Methods: 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. Results: 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). Conclusions: 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. |
Keywords: | Aspirin; mortality |
Rights: | © 2018 Massachusetts Medical Society. |
DOI: | 10.1056/NEJMoa1803955 |
Published version: | http://dx.doi.org/10.1056/nejmoa1803955 |
Appears in Collections: | Aurora harvest 4 Medicine publications |
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