Researchers cite ASPREE to inform aspirin guidelines
International researchers anticipate findings from the ASPREE study will help fill a knowledge gap that led to the exclusion of older people from recent US aspirin guidelines. Several articles in the Annals of Internal Medicine, which cited or discussed the ASPREE study, were published alongside the release of the US Preventive Services Task Force (USPSTF) final recommendations on aspirin and disease prevention.
Lack of Evidence:
The USPSTF found a shortage of high quality scientific studies meant they could not fully determine the balance of benefits and risks of aspirin for the prevention of cardiovascular disease (CVD) such as heart attack and stroke, and colorectal cancer (CRC) in people aged 70 years and older.
“There is not enough available evidence on the benefits and harms of aspirin use in adults younger than age 50 and those 70 or older to recommend for or against its use in preventing CVD and CRC.” USPSTF consumer guide said.
To coincide with the release of the USPSTF findings, several international researchers published papers which cited the ASPREE study to help address the knowledge gap:
- “More robust and comprehensive trial data involving representative patient samples on low-dose aspirin use for primary prevention should address all-cause mortality; CVD and cancer incidence and mortality; bleeding and other major harms; and emerging potential benefits, such as preventing cognitive decline. Multiple ongoing trials (56) (54 –57) …..will provide some of this essential information” (Whitlock EP, et al. Bleeding Risks with Aspirin Use for Primary Prevention in Adults: A Systematic Review for the U.S. Preventive Services Task Force. online 12 April 2016; doi:10.7326/M15-2112)
- “On the basis of relatively limited and generally lower-quality evidence, we conclude that the most consistent evidence of subpopulation differences in aspirin use was an enhanced effect on MI in older age
groups. A large ongoing trial of 19 000 participants aged 70 years or older may confirm this finding (50) (Guirguis-Blake JM, et al. Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force. Ann Intern Med. online 12 April 2016 doi:10.7326/M15-211)
- “The primary data for aspirin’s effects on a range of health outcomes have not changed substantially over the past several years, but the field is poised to provide additional data in the near future. Several large trials are in progress (77) (77– 80).” (Chubak J, et al. Aspirin for the Prevention of Cancer Incidence and Mortality: Systematic Evidence Reviews for the U.S. Preventive Services
Task Force. Ann Intern Med. online 12 April 2016 doi:10.7326/M15-2117)
- “Results from the ongoing ASPREE (Aspirin in Reducing Events in the Elderly) trial (56) may help to fill data gaps among older populations.” (Dehmer SP, et al. Aspirin for the Primary Prevention of Cardiovascular Disease and Colorectal Cancer: A Decision Analysis for the U.S. Preventive Services Task Force. Ann Intern Med. online 12 April 2016 doi:10.7326/M15-2129)
Editorial by Oxford University Professor Colin Baigent in the Annal of Internal Medicine, highlighted the importance of research on health recommendations, “..we should not rush to judgement with inadequate data. Instead, we should encourage completion (and long-term follow-up) of the ongoing trials so that the quality of the evidence in future years provides a firm found
ation for public policy.”
Who was included in the recommendations?
The USPSTF found sufficient evidence to find aspirin could help prevent CVD and CRC in people aged 50 to 69 years who are at increased risk of developing CVD.
“People 60 to 69 years old with increased cardiovascular risk can also benefit from taking aspirin. However, the overall benefit for this group is smaller and therefore the decision to take aspirin should be made with a primary care clinician, based on patients’ risk of cardiovascular disease and bleeding, their overall health, and their personal values and preferences,” said the USPSTF Bulletin.
The American Academy of Family Physicians has adopted the USPSTF’s aspirin recommendations. Results from the ASPREE study are expected in 2018.
Anyone considering taking daily aspirin should always speak to their GP beforehand.