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
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