Current Medical Issues

EVIDENCE BASED MEDICINE - SUMMARY OF STUDY
Year
: 2018  |  Volume : 16  |  Issue : 3  |  Page : 99--100

Aspirin may be related to an increased death rate, especially from cancer-related deaths


Ann Helen Prasad 
 Christian Medical College, Vellore, Tamil Nadu, India

Correspondence Address:
Dr. Ann Helen Prasad
Christian Medical College, Vellore, Tamil Nadu
India




How to cite this article:
Prasad AH. Aspirin may be related to an increased death rate, especially from cancer-related deaths.Curr Med Issues 2018;16:99-100


How to cite this URL:
Prasad AH. Aspirin may be related to an increased death rate, especially from cancer-related deaths. Curr Med Issues [serial online] 2018 [cited 2019 Jul 16 ];16:99-100
Available from: http://www.cmijournal.org/text.asp?2018/16/3/99/245041


Full Text

Source: This is a summary of the study: Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. The New England Journal of Medicine. 2018.[1] Summary Prepared by Dr. Ann Helen Prasad, Christian Medical College, Vellore, Tamil Nadu, India.

Clinical Question: What contributes to the increase in the all-cause mortality when low-dose aspirin is used in the healthy elderly?

Authors' conclusions: (1) Cancer is the major contributor to the higher all-cause mortality seen in the ASPREE trial when low-dose aspirin is used in the healthy elderly. (2) The contribution of hemorrhage to the higher all-cause mortality is small.

 Why this Study?



Aspirin is known to be beneficial in the secondary prevention of cardiovascular diseases.[2],[3] The benefit of aspirin in the primary prevention of cardiovascular disease is unclear.[4] Since the elderly are thought to be at a higher risk for cardiovascular diseases, the use of aspirin in them could be beneficial. However, the use of aspirin is also associated with an increased risk of bleeding.[5] The Aspirin in Reducing Events in the Elderly (ASPREE) trial was conducted to establish whether the use of aspirin in the healthy elderly is associated with a prolongation of life.[6] The study found that aspirin did not prolong the life of the elderly and was associated with a higher incidence of hemorrhage. The group that received aspirin had a numerically higher rate of death from any cause than the group that received placebo. The current study was conducted to examine the specific causes of death in the aspirin group.

 Results



The risk of death from any cause was 12.7 and 11.1 events per 1000 person-years in the aspirin and placebo groups, respectively (hazard ratio, 1.14; 95% confidence interval [CI] 1.01–1.29).

[INLINE:1]

The major cause of death in the aspirin group was cancer, which contributed to 49.6% of all deaths. Cardiovascular diseases contributed to 19.3% of all deaths and major hemorrhage to only 5%. The risk of cancer-related death was higher in the aspirin group than in the placebo group (hazard ratio, 1.31; 95% CI, 1.1–1.56). This was especially true of the rate of gastrointestinal cancers. There was also a higher incidence of cancer in the aspirin group when compared with the placebo group.

 Discussion



The randomized, placebo-controlled ASPREE trial found that the use of 100 mg/day of aspirin did not prolong the disability-free survival of the elderly.[6] Death from any cause was higher in the aspirin group compared to the placebo group. The current study was performed to determine the specific causes of death that contributed to the higher all-cause mortality in the aspirin group.

Hemorrhagic events, including hemorrhagic strokes, contributed only minimally to the cause of death. The higher mortality rate in the aspirin group was accounted by the higher rate of cancer-related death. Previous studies do not show such an increase in cancer-related mortality. A meta-analysis of previous randomized trials shows that aspirin is protective against cancer-related death.[7]

The ASPREE trial hence concludes that the use of low-dose aspirin in the elderly does not prolong life and may be associated with a higher risk of cancer-related deaths. It also shows that while hemorrhagic events are more common in the aspirin group, they contribute only minimally to death.

 Strengths



The trial had a large sample sizeThere was access to clinical records that made it possible to determine the underlying and proximal causes of death.

Limitations

The period of follow-up was limited. Hence, the possibility of the long-term protective effect of aspirin against cancer could not be assessedThe statistical power of the study was not sufficient to make conclusions on the effect of aspirin on mortality among the US-based subgroup of participants.

Financial support and sponsorship

This trial was supported by grants from the National Institute on Aging and National Cancer Institute at the Institutes of Health, the National Health and Medical Research Council of Australia, and Monash University and the Victorian Cancer Agency.

Conflicts of interest

There are no conflicts of interest.

References

1McNeil JJ, Nelson MR, Woods RL, Lockery JE, Wolfe R, Reid CM, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med 2018. doi: 10.1056/NEJMoa1803955.
2Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002;324:71-86.
3Antithrombotic Trialists' (ATT) Collaboration, Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, et al. Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60.
4Sutcliffe P, Connock M, Gurung T, Freeman K, Johnson S, Kandala NB, et al. Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: A systematic review and overview of reviews. Health Technol Assess 2013;17:1-253.
5Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV. Bleeding risks with aspirin use for primary prevention in adults: A systematic review for the U.S. preventive services task force. Ann Intern Med 2016;164:826-35.
6McNeil JJ, Woods RL, Nelson MR, Reid CM, Kirpach B, Wolfe R, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018. doi: 10.1056/NEJMoa1800722.
7Rothwell PM, Fowkes FG, Belch JF, Ogawa H, Warlow CP, Meade TW, et al. Effect of daily aspirin on long-term risk of death due to cancer: Analysis of individual patient data from randomised trials. Lancet 2011;377:31-41.