Abstract B93: Nonsteroidal anti-inflammatory drugs and all-cause mortality, cancer mortality, and cardiovascular mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.
Authors: Daugherty Sarah E. , Berndt Sonja I. , Purdue Mark , Huang Wen-yi 
Published: January 2014

Background: Once daily use of aspirin has been associated with a reduction in risk for cancer and cardiovascular mortality outcomes. More frequent use of aspirin and ibuprofen has not been well studied. We evaluated the association between aspirin and ibuprofen use and risk of all-cause mortality, cancer mortality, and cardiovascular disease mortality within the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.

Methods: Participants included 72,242 male and 70,978 female participants aged 55-74 with no history of cancer at baseline enrolled in the trial between 1993-2001. The frequency of aspirin and ibuprofen use one year prior to baseline was ascertained through self-administered questionnaires and causes of mortality were ascertained by linkage to the National Death Index. Multivariate hazard ratios (HRs) and 95% confidence intervals (CI) were estimated using Cox proportional hazards models.

Results: During follow-up, 14,721 deaths due to all causes, 7,069 deaths due to cancer, and 5,281 deaths due to cardiovascular disease were identified. A J-shaped risk curve for all-cause mortality was observed among exclusive aspirin users compared to those not taking either aspirin or ibuprofen. Although reductions in risk for mortality were observed among individuals who reported using aspirin less than daily (HR=0.90, 95%CI: 0.84-0.96 for all-cause mortality), a significant increase in risk for all-cause mortality (HR=1.21; 95% CI 1.12-1.31), cancer mortality (HR=1.12; 95% CI 0.99-1.25), and cardiovascular mortality (HR=1.23; 95% CI 1.09-1.40) was observed among individuals who reported taking aspirin more than once daily. The significant elevation in risk for all-cause mortality among exclusive aspirin users remained (HR=1.17; 95% CI 1.05-1.29) even after exclusion of deaths within the first six years of follow-up. Similar reductions in risk for mortality outcomes were observed for daily or less than daily use of ibuprofen and for the combined use of aspirin and ibuprofen, although no significant elevations in risk were observed overall among individuals who reported using more than once daily.

Conclusion: This large prospective analysis observed an inverse association between all mortality outcomes and daily or less than daily use of NSAIDs. Our data did not, however, support a reduction in risk for any mortality outcomes among individuals using NSAIDs more than once daily, and may even suggest an elevation in risk for heavy aspirin users.

Citation Format: Sarah E. Daugherty, Sonja I. Berndt, Mark Purdue, Wen-yi Huang. Nonsteroidal anti-inflammatory drugs and all-cause mortality, cancer mortality, and cardiovascular mortality in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial. [abstract]. In: Proceedings of the Eleventh Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2012 Oct 16-19; Anaheim, CA. Philadelphia (PA): AACR; Cancer Prev Res 2012;5(11 Suppl):Abstract nr B93.