One might indeed think that a low daily dose of aspirin, in the elderly, is favorable to cerebrovascular health and may have a positive effect on healthy lifespan. 3 articles published in the New England Journal of Medicine provide us with the first results of the ASPREE (ASPirin in Reducing Events in the Elderly) cohort, a large study funded by the US National Institutes of Health (NIH).
ASPREE is a large, international, randomized, double-blind, placebo-controlled clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults with no history of cardiovascular events. . Clinical guidelines reiterate the benefits of aspirin for preventing heart attacks and strokes in people with vascular diseases such as coronary artery disease. But what about its effects on the risk of premature mortality? This first analysis suggests that aspirin does not prolong life, in good health and in complete autonomy, that is to say without dementia or persistent physical incapacity. However, the risk of death remains variable depending on the causes and will require,
Teams from Monash University (Melbourne), Australia, Hennepin Healthcare (Minneapolis), the National Institute on Aging (NIA/NIH) and the National Cancer Institute (NCI/NIH) followed for nearly 5 years, 19,114 people aged 65 and over at inclusion, including 16,703 in Australia and 2,411 in the United States. At inclusion, participants were free of dementia or physical disability and any condition requiring the use of aspirin. The analysis shows that:
- in all participants, treatment with 100 mg aspirin daily did not affect survival without dementia or disability;
- among participants randomly assigned to take aspirin, 90.3% remained alive at the end of treatment without physical disability or dementia vs. 90.5% for participants in the control (placebo) group;
- the rates of physical disability and dementia turn out to be almost identical in the 2 groups;
- however, the group taking aspirin had an increased risk of death compared to the placebo group: 5.9% of participants taking aspirin vs 5.2% taking placebo. This effect of aspirin had never been noted in previous studies and the researchers point out that these results should be taken with caution.
- This higher mortality rate in the treated group is mainly related to a higher rate of death from cancer. A small increase in new cases of cancer was reported in the group taking aspirin, this increase seems insignificant.
- the rates of major cardiovascular events – coronary heart disease, nonfatal heart attacks, and fatal and nonfatal ischemic strokes were similar in the aspirin and placebo groups. In the aspirin group, 448 participants suffered cardiovascular events, vs 474 in the placebo group.
- The risk of significant bleeding is higher with aspirin use, primarily in the gastrointestinal tract and brain. Clinically significant bleeding – hemorrhagic stroke, brain bleeding, gastrointestinal bleeding, or bleeding from other sites requiring transfusion or hospitalization – occurred in 361 people (3.8%) on aspirin vs 265 (2.7%) under placebo.
Continued follow-up of ASPREE participants is crucial, the researchers conclude, particularly because long-term effects on risks such as cancer and dementia risk may differ from those seen so far.
In summary, these first results help to clarify the role of aspirin in the prevention of diseases in the elderly, but there is still much to learn…
