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Low-dose aspirin does not improve survival in elderly
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A daily 100-mg dose of aspirin had no impact on disability-free survival among healthy elderly patients, and was linked to a higher rate of major hemorrhage, according to findings recently published in The New England Journal of Medicine.
“Despite the widespread use of low-dose aspirin in elderly persons who do not have a medical indication for aspirin, there is limited evidence that the beneficial effects outweigh the risks in this age group,” John J. McNeil, MB, BS, PhD, department of epidemiology and preventive medicine, Monash University, Melbourne, Australia, and colleagues wrote.
Researchers analyzed data from 19,114 patients at least 65 years of age enrolled in the ASPREE Study. Of those, 9,525 were assigned to receive aspirin and 9,589 were assigned placebo. Among all participants, 11% reported using aspirin regularly prior to the study. During the study’s final year, 62.1% of those in the aspirin group and 64.1% of those placebo group were still taking their assigned drug.
McNeil and colleagues found that over a period of 5 years, the composite rate of death, dementia, or persistent physical disability — defined as being unable or having severe difficulty in conducting at least one of the six basic daily activities studied for 6 months or more — was 21.5 events for every 1,000 person-years in the aspirin group and 21.2 for every 1,000 person-years in the placebo group (HR = 1.01; 95% CI, 0.92-1.11 There was a higher rate of major hemorrhage in the aspirin group: 3.8% vs. 2.8% (HR = 1.38; 95% CI, 1.18-1.62).
In addition, there was no difference in secondary endpoints, including death from any cause, dementia or physical disability.
“Most previous large trials of aspirin have focused on reducing the incidence of cardiovascular events as their primary endpoint. However, in this age group, the long-term use of a preventive drug may be justified by a prolongation of the time spent in a healthy independent state,” McNeil and colleagues wrote. “An endpoint that reflects this outcome should integrate the beneficial effects and the serious adverse effects of a preventive agent such as aspirin.
Although the findings are important, future research is needed to put the findings in context before patients stop taking their daily aspirin regimens, Evan Hadley, MD, director of National Institute on Aging’s division of geriatrics and clinical gerontology said in press release.
“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. These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. The ASPREE team is continuing to analyze the results of this study and has implemented plans for monitoring participants,” he said.
In the meantime, Hadley stressed that older adults should still continue to follow their physicians’ advice regarding daily aspirin use. – by Janel Miller
Disclosure: McNeil reports non-financial support from Bayer AG, during the conduct of the study. Please see the study for all other authors’ relevant financial disclosures.