Effect of aspirin on cardiovascular events and bleeding in the healthy elderly

Journal article


McNeil, John J., Wolfe, Rory, Woods, Robyn L., Tonkin, Andrew M., Donnan, Geoffrey A., Nelson, Mark R., Reid, Christopher M., Lockery, Jessica E., Kirpach, Brenda, Storey, Elsdon, Shah, Raj C., Margolis, Karen L., Ernst, Michael E., Abhayaratna, Walter P., Stocks, Nigel, Fitzgerald, Sharyn M., Orchard, Suzanne G., Trevaks, Ruth E., Beilin, Lawrence J., ... Murray, Anne M.. (2018). Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. New England Journal of Medicine. 379(16), pp. 1509-1518. https://doi.org/10.1056/NEJMoa1805819
AuthorsMcNeil, John J., Wolfe, Rory, Woods, Robyn L., Tonkin, Andrew M., Donnan, Geoffrey A., Nelson, Mark R., Reid, Christopher M., Lockery, Jessica E., Kirpach, Brenda, Storey, Elsdon, Shah, Raj C., Margolis, Karen L., Ernst, Michael E., Abhayaratna, Walter P., Stocks, Nigel, Fitzgerald, Sharyn M., Orchard, Suzanne G., Trevaks, Ruth E., Beilin, Lawrence J., Johnston, Colin I., Radziszewska, Barbara, Jelinek, Michael, Malik, Mobin, Eaton, Charles B., Brauer, Donna, Cloud, Geoff, Wood, Erica M., Mahady, Suzanne E., Satterfield, Suzanne, Grimm, Richard and Murray, Anne M.
Abstract

BACKGROUND
Aspirin is a well-established therapy for the secondary prevention of cardiovascular events. However, its role in the primary prevention of cardiovascular disease is unclear, especially in older persons, who have an increased risk.

METHODS
From 2010 through 2014, we enrolled community-dwelling men and women 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. The primary end point was a composite of death, dementia, or persistent physical disability; results for this end point are reported in another article in the Journal. Secondary end points included major hemorrhage and cardiovascular disease (defined as fatal coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal stroke, or hospitalization for heart failure).

RESULTS
Of the 19,114 persons who were enrolled in the trial, 9525 were assigned to receive aspirin and 9589 to receive placebo. After a median of 4.7 years of follow-up, the rate of cardiovascular disease was 10.7 events per 1000 person-years in the aspirin group and 11.3 events per 1000 person-years in the placebo group (hazard ratio, 0.95; 95% confidence interval [CI], 0.83 to 1.08). The rate of major hemorrhage was 8.6 events per 1000 person-years and 6.2 events per 1000 person-years, respectively (hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001).

CONCLUSIONS
The use of low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo. (Funded by the National Institute on Aging and others; ASPREE ClinicalTrials.gov number, NCT01038583. opens in new tab.)

Year2018
JournalNew England Journal of Medicine
Journal citation379 (16), pp. 1509-1518
PublisherMassachusetts Medical Society
ISSN0028-4793
Digital Object Identifier (DOI)https://doi.org/10.1056/NEJMoa1805819
PubMed ID30221597
Scopus EID2-s2.0-85054684581
PubMed Central IDPMC6289056
Research or scholarlyResearch
Page range1509-1518
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online18 Oct 2018
Publication process dates
Deposited14 Jan 2022
Permalink -

https://acuresearchbank.acu.edu.au/item/8x477/effect-of-aspirin-on-cardiovascular-events-and-bleeding-in-the-healthy-elderly

Restricted files

Publisher's version

  • 117
    total views
  • 0
    total downloads
  • 0
    views this month
  • 0
    downloads this month
These values are for the period from 19th October 2020, when this repository was created.

Export as

Related outputs

Prediction of incident heart failure by serum amino-terminal pro-B-type natriuretic peptide level in a community-based cohort
Campbell, Duncan J., Gong, Fei Fei, Jelinek, Michael V., Castro, Julian M., Coller, Jennifer M., McGrady, Michele, Boffa, Umberto, Shiel, Louise, Wang, Bing H., Liew, Danny, Wolfe, Rory, Stewart, Simon, Owen, Alice J., Krum, Henry, Reid, Christopher M. and Prior, David L.. (2019). Prediction of incident heart failure by serum amino-terminal pro-B-type natriuretic peptide level in a community-based cohort. European Journal of Heart Failure. 21, pp. 449-459. https://doi.org/10.1002/ejhf.1381
Mild depression predicts long-term mortality after acute myocardial infarction : A 25-year follow-up
Worcester, Marian U., Goble, Alan J., Elliott, Peter C., Froelicher, Erika S., Murphy, Barbara M., Beauchamp, Alison J., Jelinek, Michael V. and Hare, David L.. (2019). Mild depression predicts long-term mortality after acute myocardial infarction : A 25-year follow-up. Heart, Lung and Circulation. 28, pp. 1812-1818. https://doi.org/10.1016/j.hlc.2018.11.013
Implications of Cardio-Respiratory Fitness on the Performance of Exercise Tests
Michael Jelinek and Kenneth Hossack. (2019). Implications of Cardio-Respiratory Fitness on the Performance of Exercise Tests. Heart, Lung and Circulation. 28(4), pp. 64-66. https://doi.org/10.1016/j.hlc.2018.07.015
Coaching Patients Saves Lives and Money
Joshua Byrnes, Thomas Elliott, Margarite Vale, Michael Jelinek and Paul Scuffham. (2018). Coaching Patients Saves Lives and Money. American Journal of Medicine. 131(4), pp. 415-422. https://doi.org/10.1016/j.amjmed.2017.10.019
Risk factors for incident heart failure with preserved or reduced ejection fraction, and valvular heart failure, in a community-based cohort
Gong, Fei Fei, Jelinek, Michael, Castro, Julian M., Coller, Jennifer M., McGrady, Michele, Boffa, Umberto, Shiel, Louise, Liew, Danny, Wolfe, R., Stewart, Simon, Owen, Alice J., Krum, Henry, Reid, Christopher, Prior, David and Campbell, Duncan J.. (2018). Risk factors for incident heart failure with preserved or reduced ejection fraction, and valvular heart failure, in a community-based cohort. Open Heart. 5(2), pp. 1 - 11. https://doi.org/10.1136/openhrt-2018-000782
Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring
Christian R. Hamilton-Craig, Clara Chow, John F. Younger, Michael Jelinek, Jonathan Chan and Gary Y. H. Liew. (2017). Cardiac Society of Australia and New Zealand position statement executive summary: coronary artery calcium scoring. Medical Journal of Australia. 207(8), pp. 357-361. https://doi.org/10.5694/mja16.01134
SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes [SMART-REHAB Trial]: A randomized controlled trial protocol
Yudi, Matias B., Clark, David J., Tsang, David, Jelinek, Michael, Kalten, Katie, Joshi, Subodh, Phan, Khoa, Nasis, Arthur, Amerena, John, Arunothayaraj, Sandeep, Reid, Chris and Farouque, Omar. (2016). SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes [SMART-REHAB Trial]: A randomized controlled trial protocol. BMC Cardiovascular Disorders. 16(170), pp. 1 - 8. https://doi.org/10.1186/s12872-016-0356-6
Improving access and equity in reducing cardiovascular risk : The Queensland Health Model
Ski, Chantal, Vale, Margarite, Bennett, Gary, Chalmers, Victoria, McFarlane, Kim, Jelinek, Michael, Scott, Ian and Thompson, David. (2015). Improving access and equity in reducing cardiovascular risk : The Queensland Health Model. Medical Journal of Australia. 202(3), pp. 148 - 152. https://doi.org/10.5694/mja14.00575
Reversing social disadvantage in secondary prevention of coronary heart disease
Jelinek, Michael, Santamaria, John, Best, James, Thompson, David R., Tonkin, Andrew and Vale, Margarite. (2014). Reversing social disadvantage in secondary prevention of coronary heart disease. International Journal of Cardiology. 171(3), pp. 346 - 350. https://doi.org/10.1016/j.ijcard.2013.12.022
'FIT FOR PURPOSE'. The COACH program improves lifestyle and biomedical cardiac risk factors
Jelinek, Michael, Santamaria, John, Thompson, David and Vale, Margarite. (2012). 'FIT FOR PURPOSE'. The COACH program improves lifestyle and biomedical cardiac risk factors. Heart. 98(21), pp. 1608 - 1608. https://doi.org/10.1136/heartjnl-2012-302723
Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease
Jelinek, Michael, Clark, Alexander, Oldridge, Neil, Briffa, Thomas and Thompson, David Robert. (2011). Reconciling systematic reviews of exercise-based cardiac rehabilitation and secondary prevention programmes for coronary heart disease. European Journal of Cardiovascular Prevention & Rehabilitation. 18(2), pp. 147 - 149. https://doi.org/10.1177/1741826710389388
Screening for depression in coronary heart disease: The perfect Hegelian dialectic? A short commentary on ''Beyond the blues: The need for integrated care pathways''
Jelinek, Michael. (2011). Screening for depression in coronary heart disease: The perfect Hegelian dialectic? A short commentary on ''Beyond the blues: The need for integrated care pathways''. European Journal of Cardiovascular Prevention & Rehabilitation. 18(2), pp. 222 - 223. https://doi.org/10.1177/1741826710389411