Monday, 8 August 2016

ASPREE trial is poised to inform future aspirin guidelines according to US

SPHPM is home to the ASPREE (ASPirin in Reducing Events in the Elderly) trial, a double-blind placebo controlled primary prevention aspirin study with 19,114 participants – 16,703 in Australia and 2,411 from the US.

ASPREE, Australia’s largest clinical trial, was recently recognised by international researchers for investigating the benefits versus the risks of aspirin in the healthy elderly.

The researchers anticipate ASPREE study findings will help fill a vital knowledge gap that led to the exclusion of older people from the latest US aspirin guidelines.

Several articles in the Annals of Internal Medicine, discussed the ASPREE study and were published alongside the release of the US Preventive Services Task Force (USPSTF) final recommendations on aspirin and disease prevention.

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,” the USPSTF consumer guide said.

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.

Listed below are the aforementioned articles:

“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 foundation for public policy.”

Results from the ASPREE study are expected in 2018. Anyone considering taking daily aspirin should always speak to their GP beforehand.

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