Please use this identifier to cite or link to this item: http://hdl.handle.net/2440/120005
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Type: Journal article
Title: Effect of aspirin on all-cause mortality in the healthy elderly
Author: McNeil, J.
Nelson, M.
Woods, R.
Lockery, J.
Wolfe, R.
Reid, C.
Kirpach, B.
Shah, R.
Ives, D.
Storey, E.
Ryan, J.
Tonkin, A.
Newman, A.
Williamson, J.
Margolis, K.
Ernst, M.
Abhayaratna, W.
Stocks, N.
Fitzgerald, S.
Orchard, S.
et al.
Citation: New England Journal of Medicine, 2018; 379(16):1519-1528
Publisher: Massachusetts Medical Society
Issue Date: 2018
ISSN: 0028-4793
1533-4406
Statement of
Responsibility: 
J.J. McNeil, M.R. Nelson, R.L. Woods, J.E. Lockery, R. Wolfe, C.M. Reid, B. Kirpach, R.C. Shah, D.G. Ives, E. Storey, J. Ryan, A.M. Tonkin, A.B. Newman, J.D. Williamson, K.L. Margolis, M.E. Ernst, W.P. Abhayaratna, N. Stocks, S.M. Fitzgerald, S.G. Orchard, R.E. Trevaks, L.J. Beilin, G.A. Donnan, P. Gibbs, C.I. Johnston, B. Radziszewska, R. Grimm, and A.M. Murray [for the ASPREE Investigator Group]
Abstract: Background: In the primary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, now published in the Journal, we report that the daily use of aspirin did not provide a benefit with regard to the primary end point of disability-free survival among older adults. A numerically higher rate of the secondary end point of death from any cause was observed with aspirin than with placebo. Methods: From 2010 through 2014, we enrolled community-dwelling persons 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. Deaths were classified according to the underlying cause by adjudicators who were unaware of trial-group assignments. Hazard ratios were calculated to compare mortality between the aspirin group and the placebo group, and post hoc exploratory analyses of specific causes of death were performed. Results: Of the 19,114 persons who were enrolled, 9525 were assigned to receive aspirin and 9589 to receive placebo. A total of 1052 deaths occurred during a median of 4.7 years of follow-up. The risk of death from any cause was 12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group (hazard ratio, 1.14; 95% confidence interval [CI], 1.01 to 1.29). Cancer was the major contributor to the higher mortality in the aspirin group, accounting for 1.6 excess deaths per 1000 person-years. Cancer-related death occurred in 3.1% of the participants in the aspirin group and in 2.3% of those in the placebo group (hazard ratio, 1.31; 95% CI, 1.10 to 1.56). Conclusions: Higher all-cause mortality was observed among apparently healthy older adults who received daily aspirin than among those who received placebo and was attributed primarily to cancer-related death. In the context of previous studies, this result was unexpected and should be interpreted with caution.
Keywords: Aspirin; mortality
Rights: © 2018 Massachusetts Medical Society.
RMID: 0030099251
DOI: 10.1056/NEJMoa1803955
Appears in Collections:Medicine publications

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