Effect of aspirin on cancer incidence and mortality in older adults.
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© The Author(s) (2020). Published by Oxford University Press.
This is a pre-copyedited, author-produced version of an article accepted for publication in Journal of the National Cancer Institute following peer review. The version of record McNeil, J.J. and Gibbs, P. and Orchard, S.G. and Lockery, J.E. and Bernstein, W.B. and Cao, Y. and Ford, L. et al. 2020. Effect of aspirin on cancer incidence and mortality in older adults. Journal of the National Cancer Institut is available online at: https://doi.org/10.1093/jnci/djaa114.
BACKGROUND: ASPirin in Reducing Events in the Elderly (ASPREE), a randomized double-blind placebo-controlled trial (RCT) of daily low-dose aspirin (100 mg) in older adults, showed an increase in all-cause mortality, primarily due to cancer. In contrast prior RCTs, mainly involving younger individuals, demonstrated a delayed cancer benefit with aspirin. We now report a detailed analysis of cancer incidence and mortality. METHODS: 19,114 Australian and U.S. community-dwelling participants aged 70+ years (U.S. minorities 65+ years) without cardiovascular disease, dementia or physical disability were randomized and followed for a median of 4.7 years. Fatal and non-fatal cancer events, a prespecified secondary endpoint, were adjudicated based on clinical records. RESULTS: 981 cancer events occurred in the aspirin and 952 in the placebo groups. There was no statistically significant difference between groups for all incident cancers (HR = 1.04, 95% CI = 0.95 to 1.14), hematological cancer (HR = 0.98, 95% CI = 0.73 to 1.30), or all solid cancers (HR = 1.05, 95% CI = 0.95 to 1.15), including by specific tumor type. However, aspirin was associated with an increased risk of incident cancer that had metastasized (HR = 1.19, 95% CI = 1.00 to 1.43) or was stage 4 at diagnosis (HR = 1.22, 95% CI = 1.02 to 1.45), and with higher risk of death for cancers that presented at stages 3 (HR = 2.11, 95% CI = 1.03 to 4.33) or 4 (HR = 1.31, 95% CI = 1.04 to 1.64). CONCLUSIONS: In older adults, aspirin treatment had an adverse effect on later stages of cancer evolution. These findings suggest that in older persons, aspirin may accelerate the progression of cancer and thus, suggest caution with its use in this age group.
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Effect of Aspirin vs Placebo on the Prevention of Depression in Older People: A Randomized Clinical TrialBerk, M.; Berk, M.; Woods, R.L.; Nelson, M.R.; Shah, R.C.; Reid, C.M.; Reid, Christopher ; Storey, E.; Fitzgerald, S.; Lockery, J.E.; Wolfe, R.; Mohebbi, M.; Mohebbi, M.; Dodd, S.; Murray, A.M.; Stocks, N.; Fitzgerald, P.B.; Mazza, C.; Agustini, B.; McNeil, J.J. (2020)© 2020 American Medical Association. All rights reserved. Importance: Depression is associated with increased inflammation, which may precede its onset, especially in older people. Some preclinical data suggest potential ...
McNeil, J.; Nelson, M.; Woods, R.; Lockery, J.; Wolfe, R.; Reid, Christopher; 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.; Trevaks, R.; Beilin, L.; Donnan, G.; Gibbs, P.; Johnston, C.; Radziszewska, B.; Grimm, R.; Murray, A. (2018)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 ...
Ryan, Joanne; Storey, Elsdon; Murray, Anne M; Woods, Robyn L; Wolfe, Rory; Reid, Christopher ; Nelson, Mark R; Chong, Trevor TJ; Williamson, Jeff D; Ward, Stephanie A; Lockery, Jessica E; Orchard, Suzanne G; Trevaks, Ruth; Kirpach, Brenda; Newman, Anne B; Ernst, Michael E; McNeil, John J; Shah, Raj C; ASPREE Investigator Group (2020)OBJECTIVE: To determine the effect of low-dose aspirin vs placebo on incident all-cause dementia, incident Alzheimer disease (AD), mild cognitive impairment (MCI), and cognitive decline in older individuals. METHODS: ...