POEMs

Patient-Oriented Evidence That Matters

In Healthy Older Adults, Low-Dose Aspirin Increases All-Cause and Cancer-Specific Mortality

 

Am Fam Physician. 2019 Jul 15;100(2):118-119.

Clinical Question

Does low-dose aspirin reduce all-cause mortality in generally healthy older adults?

Bottom Line

The findings are completely unexpected. Although recent studies by this group and other groups of researchers have failed to find a cardiovascular benefit, likely because of better control of other cardiovascular risk factors, this study found increased all-cause mortality, primarily due to increased cancer-related mortality. Other studies, such as the individual patient meta-analysis by Rothwell and colleagues (Lancet. 2011;377(9759):31–41), found the opposite. A Bayesian thinker would urge caution in interpreting these results, considering the existing body of research concluding the opposite regarding cancer-specific mortality. (Level of Evidence = 1b)

Synopsis

This is one of three reports of the same study in the same issue of the New England Journal of Medicine; this one focuses on all-cause mortality. The Aspirin in Reducing Events in the Elderly trial randomized 19,114 community-dwelling adults to receive 100 mg of enteric-coated aspirin or placebo. The study was conducted in the United States and Australia, with patients recruited between 2010 and 2014. Participants were 70 years or older (65 years or older if black or Hispanic in the United States, because of their shorter average lifespan), had no serious comorbidity that would be expected to limit their life expectancy to less than five years, and no known cardiovascular or cerebrovascular disease, dementia, high bleeding risk, or contraindication to aspirin. The study included a one-month placebo run-in period to ensure at least 80% adherence to the study medication. During the run-in period, 4,049 patients were excluded, 61% because of failed adherence. Included patients were contacted every three months to further encourage adherence and to gather interim data. Outcomes were adjudicated by a committee masked to treatment assignment. The median age of participants was 74 years, 56% were women, and 8.7% were


Editor's Note: Dr. Ebell is Deputy Editor for Evidence-Based Medicine for AFP and cofounder and Editor-in-Chief of Essential Evidence Plus.

POEMs (patient-oriented evidence that matters) are provided by Essential Evidence Plus, a point-of-care clinical decision support system published by Wiley-Blackwell. For more information, see http://www.essentialevidenceplus.com. Copyright Wiley-Blackwell. Used with permission.

For definitions of levels of evidence used in POEMs, see http://www.essentialevidenceplus.com/product/ebm_loe.cfm?show=oxford.

To subscribe to a free podcast of these and other POEMs that appear in AFP, search in iTunes for “POEM of the Week” or go to http://goo.gl/3niWXb.

This series is coordinated by Sumi Sexton, MD, Editor-in-Chief.

A collection of POEMs published in AFP is available at https://www.aafp.org/afp/poems.

 

 

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