Effect of aspirin on disability-free survival in the healthy elderly

J. J. McNeil, R. L. Woods, M. R. Nelson, C. M. Reid, B. R. Kirpach, R. Wolfe, E. Storey, R. C. Shah, J. E. Lockery, A.M. Tonkin, A. B. Newman, J. D. Williamson, K. L. Margolis, M. E. Ernst, W. P. Abhayaratna, N. Stocks, D. G. Ives, S. M. Fitzgerald, S. G. Orchard, R. E. Trevaks & 9 others L. J. Beilin, G. A. Donnan, P. Gibbs, C. I. Johnston, J. Ryan, B. Radziszewska, R. Grimm, A. M. Murray, for the ASPREE Investigator Group

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Abstract

Background: Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disabilityfree life in healthy seniors is unclear. 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 physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage. Results: A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11; P = 0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001). Conclusions: Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.

Original languageEnglish
Pages (from-to)1499-1508
Number of pages10
JournalNew England Journal of Medicine
Volume379
Issue number16
DOIs
Publication statusPublished - 18 Oct 2018

Cite this

McNeil, J. J. ; Woods, R. L. ; Nelson, M. R. ; Reid, C. M. ; Kirpach, B. R. ; Wolfe, R. ; Storey, E. ; Shah, R. C. ; Lockery, J. E. ; Tonkin, A.M. ; Newman, A. B. ; Williamson, J. D. ; Margolis, K. L. ; Ernst, M. E. ; Abhayaratna, W. P. ; Stocks, N. ; Ives, D. G. ; Fitzgerald, S. M. ; Orchard, S. G. ; Trevaks, R. E. ; Beilin, L. J. ; Donnan, G. A. ; Gibbs, P. ; Johnston, C. I. ; Ryan, J. ; Radziszewska, B. ; Grimm, R. ; Murray, A. M. ; for the ASPREE Investigator Group. / Effect of aspirin on disability-free survival in the healthy elderly. In: New England Journal of Medicine. 2018 ; Vol. 379, No. 16. pp. 1499-1508.
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title = "Effect of aspirin on disability-free survival in the healthy elderly",
abstract = "Background: Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disabilityfree life in healthy seniors is unclear. 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 physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage. Results: A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4{\%} of the participants were women, 8.7{\%} were nonwhite, and 11.0{\%} reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95{\%} confidence interval [CI], 0.92 to 1.11; P = 0.79). The rate of adherence to the assigned intervention was 62.1{\%} in the aspirin group and 64.1{\%} in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8{\%} vs. 2.8{\%}; hazard ratio, 1.38; 95{\%} CI, 1.18 to 1.62; P<0.001). Conclusions: Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.",
author = "McNeil, {J. J.} and Woods, {R. L.} and Nelson, {M. R.} and Reid, {C. M.} and Kirpach, {B. R.} and R. Wolfe and E. Storey and Shah, {R. C.} and Lockery, {J. E.} and A.M. Tonkin and Newman, {A. B.} and Williamson, {J. D.} and Margolis, {K. L.} and Ernst, {M. E.} and Abhayaratna, {W. P.} and N. Stocks and Ives, {D. G.} and Fitzgerald, {S. M.} and Orchard, {S. G.} and Trevaks, {R. E.} and Beilin, {L. J.} and Donnan, {G. A.} and P. Gibbs and Johnston, {C. I.} and J. Ryan and B. Radziszewska and R. Grimm and Murray, {A. M.} and {for the ASPREE Investigator Group}",
year = "2018",
month = "10",
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doi = "10.1056/NEJMoa1800722",
language = "English",
volume = "379",
pages = "1499--1508",
journal = "New England Journal of Medicine",
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McNeil, JJ, Woods, RL, Nelson, MR, Reid, CM, Kirpach, BR, Wolfe, R, Storey, E, Shah, RC, Lockery, JE, Tonkin, AM, Newman, AB, Williamson, JD, Margolis, KL, Ernst, ME, Abhayaratna, WP, Stocks, N, Ives, DG, Fitzgerald, SM, Orchard, SG, Trevaks, RE, Beilin, LJ, Donnan, GA, Gibbs, P, Johnston, CI, Ryan, J, Radziszewska, B, Grimm, R, Murray, AM & for the ASPREE Investigator Group 2018, 'Effect of aspirin on disability-free survival in the healthy elderly', New England Journal of Medicine, vol. 379, no. 16, pp. 1499-1508. https://doi.org/10.1056/NEJMoa1800722

Effect of aspirin on disability-free survival in the healthy elderly. / McNeil, J. J.; Woods, R. L.; Nelson, M. R.; Reid, C. M.; Kirpach, B. R.; Wolfe, R.; Storey, E.; Shah, R. C.; Lockery, J. E.; Tonkin, A.M.; Newman, A. B.; Williamson, J. D.; Margolis, K. L.; Ernst, M. E.; Abhayaratna, W. P.; Stocks, N.; Ives, D. G.; Fitzgerald, S. M.; Orchard, S. G.; Trevaks, R. E.; Beilin, L. J.; Donnan, G. A.; Gibbs, P.; Johnston, C. I.; Ryan, J.; Radziszewska, B.; Grimm, R.; Murray, A. M.; for the ASPREE Investigator Group.

In: New England Journal of Medicine, Vol. 379, No. 16, 18.10.2018, p. 1499-1508.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Effect of aspirin on disability-free survival in the healthy elderly

AU - McNeil, J. J.

AU - Woods, R. L.

AU - Nelson, M. R.

AU - Reid, C. M.

AU - Kirpach, B. R.

AU - Wolfe, R.

AU - Storey, E.

AU - Shah, R. C.

AU - Lockery, J. E.

AU - Tonkin, A.M.

AU - Newman, A. B.

AU - Williamson, J. D.

AU - Margolis, K. L.

AU - Ernst, M. E.

AU - Abhayaratna, W. P.

AU - Stocks, N.

AU - Ives, D. G.

AU - Fitzgerald, S. M.

AU - Orchard, S. G.

AU - Trevaks, R. E.

AU - Beilin, L. J.

AU - Donnan, G. A.

AU - Gibbs, P.

AU - Johnston, C. I.

AU - Ryan, J.

AU - Radziszewska, B.

AU - Grimm, R.

AU - Murray, A. M.

AU - for the ASPREE Investigator Group

PY - 2018/10/18

Y1 - 2018/10/18

N2 - Background: Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disabilityfree life in healthy seniors is unclear. 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 physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage. Results: A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11; P = 0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001). Conclusions: Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.

AB - Background: Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disabilityfree life in healthy seniors is unclear. 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 physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major hemorrhage. Results: A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were nonwhite, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11; P = 0.79). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%; hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001). Conclusions: Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major hemorrhage than placebo.

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U2 - 10.1056/NEJMoa1800722

DO - 10.1056/NEJMoa1800722

M3 - Article

VL - 379

SP - 1499

EP - 1508

JO - New England Journal of Medicine

JF - New England Journal of Medicine

SN - 0028-4793

IS - 16

ER -