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The results are in on the ASPREE trial

A study in Australia and the US was commenced almost a decade ago to assess whether being on long term aspirin increased a perfectly healthy patient’s chance of survival.  Aspirin is traditionally expected to reduce cardiovascular disease such as heart attacks or strokes, there have been studies showing a reduced cancer risk, and only a tiny increase in bleeding risk causing death.

The ASPREE trial reported in the New England Journal of Medicine, recruited 19,114 patients and had half the patients on 100mg EC aspirin daily.  Median followup was 4.7 years. In this peer reviewed journal article, they do not mention the occurrence of cardiac or stroke events, except if associated with death.  The study was stopped in June 2017 at a request of the funding agency. Perhaps it is disappointing given they physically met each patient on a quarterly basis that the only reported outcome was cause of death!

The majority of patients were Australian (87%). 5.5% of the patients died during the trial. The increased risk of death on aspirin was reported as a hazard ratio of 1.14.  No reduction in cardiovascular deaths was demonstrated, but a slight increase in the risk of cancer deaths.  This does not concord with other studies that suggest a reduction in cancer deaths in patients on aspirin.  The authors recommend caution in interpreting their results.  The first reason for caution is that they tested normal, healthy adults, who didn’t have a strong indication for aspirin treatment.


McNeil John J., Woods Robyn L., Nelson Mark R., Reid Christopher M., Kirpach Brenda, Wolfe Rory, Storey Elsdon, Shah Raj C., Lockery Jessica E., Tonkin Andrew M., Newman Anne B., Williamson Jeff D., Margolis Karen L., Ernst Michael E., Abhayaratna Walter P., Stocks Nigel, Fitzgerald Sharyn M., Orchard Suzanne G., Trevaks Ruth E., Beilin Lawrence J., Donnan Geoffrey A., Gibbs Peter, Johnston Colin I., Ryan Joanne, Radziszewska Barbara, Grimm Richard, Murray Anne M.. (2018) Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med DOI: 10.1056/NEJMoa1800722.

Elwood PC; Morgan G; Pickering JE; Galante J; Weightman AL; Morris D; Kelson M; Dolwani S, Aspirin in the Treatment of Cancer: Reductions in Metastatic Spread and in Mortality: A Systematic Review and Meta-Analyses of Published Studies. PLoS One 2016;11(4):e0152402    (ISSN: 1932-6203)