Safety of Ceasing Aspirin Used Without a Clinical Indication After Age 70 Years: A Subgroup Analysis of the ASPREE Randomized Trial
Authors: Mark R. Nelson, Galina Polekhina, Robyn L. Woods, Christopher M. Reid, Andrew M. Tonkin, Rory Wolfe, Anne M. Murray, Brenda Kirpach, Michael E. Ernst, Jessica E. Lockery, Raj C. Shah, Nigel Stocks, Suzanne G. Orchard, Zhen Zhou
Journal: Annals of Internal Medicine (2022)

LettersMay 2022Safety of Ceasing Aspirin Used Without a Clinical Indication After Age 70 Years: A Subgroup Analysis of the ASPREE Randomized TrialMark R. Nelson, MBBS(Hons), MFM, PhD, Galina Polekhina, PhD, MBiostat, Robyn L. Woods, BSc(Hons), PhD, Christopher M. Reid, PhD, MPH, Andrew M. Tonkin, MBBS, MD, Rory Wolfe, PhD, Anne M. Murray, MD, MSc, Brenda Kirpach, CCRA, Michael E. Ernst, PharmD, Jessica E. Lockery, MBBS, PhD, Raj C. Shah, MD, Nigel Stocks, MBBS, MD, Suzanne G. Orchard, BSc (Hons), PhD, Zhen Zhou, PhDMark R. Nelson, MBBS(Hons), MFM, PhDMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Galina Polekhina, PhD, MBiostatSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Robyn L. Woods, BSc(Hons), PhDSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Christopher M. Reid, PhD, MPHSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and School of Public Health, Curtin University, Perth, Western Australia, Australia, Andrew M. Tonkin, MBBS, MDSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Rory Wolfe, PhDSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Anne M. Murray, MD, MScBerman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, and Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, Minnesota, Brenda Kirpach, CCRABerman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, Minnesota, Michael E. Ernst, PharmDDepartment of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, Jessica E. Lockery, MBBS, PhDSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and Translational Immunology and Nanotechnology Research Program, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia, Raj C. Shah, MDDepartment of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, Nigel Stocks, MBBS, MDDiscipline of General Practice, The University of Adelaide, Adelaide, South Australia, Australia, Suzanne G. Orchard, BSc (Hons), PhDSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia, Zhen Zhou, PhDMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, AustraliaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-3823 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The ASPREE (ASPirin in Reducing Events in the Elderly) trial was a randomized, double-blind, placebo-controlled primary prevention trial of aspirin in 19 114 community-dwelling persons aged 70 years and older (≥65 years in U.S. racial minorities). The results of the trial demonstrated that aspirin had no benefit for disability-free survival, prevention of cardiovascular disease events, or prevention of incident cancer, and increased risk for major bleeding and all-cause mortality (1–3). These findings were interpreted by some as being relevant only to aspirin initiation and not aspirin discontinuation (4). The availability of evidence to inform the risks (for example, forgone cardiovascular ...References1. McNeil JJ, Nelson MR, Woods RL, et al; ASPREE Investigator Group. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018;379:1519-1528. [PMID: 30221595] doi:10.1056/NEJMoa1803955 CrossrefMedlineGoogle Scholar2. McNeil JJ, Wolfe R, Woods RL, et al; ASPREE Investigator Group. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. N Engl J Med. 2018;379:1509-1518. [PMID: 30221597] doi:10.1056/NEJMoa1805819 CrossrefMedlineGoogle Scholar3. McNeil JJ, Woods RL, Nelson MR, et al; ASPREE Investigator Group. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379:1499-1508. [PMID: 30221596] doi:10.1056/NEJMoa1800722 CrossrefMedlineGoogle Scholar4. Fernandes A, McEvoy JW, Halvorsen S. "Doctor, should I keep taking an aspirin a day?". N Engl J Med. 2019;380:1967-1970. [PMID: 31091380] doi:10.1056/NEJMclde1903004 CrossrefMedlineGoogle Scholar5. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596-e646. [PMID: 30879355] doi:10.1161/CIR.0000000000000678 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, and School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, AustraliaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and School of Public Health, Curtin University, Perth, Western Australia, AustraliaBerman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, and Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, MinnesotaBerman Center for Outcomes & Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, MinnesotaDepartment of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IowaSchool of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, and Translational Immunology and Nanotechnology Research Program, School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, AustraliaDepartment of Family Medicine and Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IllinoisDiscipline of General Practice, The University of Adelaide, Adelaide, South Australia, AustraliaMenzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, AustraliaAcknowledgment: The authors acknowledge the ASPREE Investigator Group (https://aspree.org) for their contributions to the original trial.Grant Support: The ASPREE (ASPirin in Reducing Events in the Elderly) trial was supported by grant U01AG029824 from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health, by grants 334047 and 1127060 from the National Health and Medical Research Council of Australia, and by Monash University and the Victorian Cancer Agency.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-3823.Data Sharing Statement: The data may be made available at the discretion of the principal investigators of the ASPREE trial (Australia: Prof. John McNeil, e-mail, john.[email protected]edu; United States: Prof. Anne Murray, e-mail, [email protected]org) on request.Corresponding Author: Mark R. Nelson, MBBS(Hons), MFM, PhD, Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania, Australia; e-mail, mark.[email protected]edu.au.This article was published at Annals.org on 15 March 2022. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDoes Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults? Ella Murphy and John W. McEvoy Metrics Cited byDoes Stopping Aspirin Differ Fundamentally From Not Starting Aspirin in the Primary Prevention of Cardiovascular Disease Among Older Adults?Ella Murphy, MB BCh BAO, MSc and John W. McEvoy, MB BCh BAO, MEd, MHS May 2022Volume 175, Issue 5Page: 761-764KeywordsAlzheimer diseaseAspirinCardiovascular diseasesClinical trialsElderlyHemorrhageMortalityRandomized trialsSafetyTreatment guidelines ePublished: 15 March 2022 Issue Published: May 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...