Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly

McNeil, John J; Wolfe, Rory; Woods, Robyn L.; Tonkin, Andrew; Donnan, Geoffrey A; Nelson, Mark; Reid, Christopher M.; Lockery, Jessica E.; Kirpach, Brenda; Storey, Elsdon; Shah, Raj C.; 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.; Johnston, Colin I.; Ryan, Joanne; Radziszewska, Barbara; Jelinek, Michael; Malik, Mobin; Eaton, Charles B.; Brauer, Donna; Cloud, Geoffrey; Wood, Erica M.; Mahady, Suzanne E.; Satterfield, Suzanne; Grimm, Richard H.; Murray, Anne M.

doi:10.1056/nejmoa1805819

Cited by 824 publications

(825 citation statements)

References 51 publications

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“…Other important changes in the use with caution table included lowering the age threshold in the aspirin for primary prevention recommendation from 80 years or younger to 70 years or younger on the basis of emerging evidence of a major increase in the risk of bleeding at a lower age . The Aspirin in Reducing Events in the Elderly (ASPREE) trial, which was published outside the window of our literature search, found that low‐dose aspirin used for primary prevention in older adults did not confer a reduction in mortality, disability‐free survival, or cardiovascular events . In a few instances, the level of evidence was revised based on new literature and the improved modified grading method.…”

Section: Discussionmentioning

confidence: 99%

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

2019

J American Geriatrics Society

2,391

1,043

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The American Geriatrics Society (AGS) Beers Criteria® (AGS Beers Criteria®) for Potentially Inappropriate Medication (PIM) Use in Older Adults are widely used by clinicians, educators, researchers, healthcare administrators, and regulators. Since 2011, the AGS has been the steward of the criteria and has produced updates on a 3‐year cycle. The AGS Beers Criteria® is an explicit list of PIMs that are typically best avoided by older adults in most circumstances or under specific situations, such as in certain diseases or conditions. For the 2019 update, an interdisciplinary expert panel reviewed the evidence published since the last update (2015) to determine if new criteria should be added or if existing criteria should be removed or undergo changes to their recommendation, rationale, level of evidence, or strength of recommendation. J Am Geriatr Soc 67:674–694, 2019.

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Section: Discussionmentioning

confidence: 99%

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

2019

J American Geriatrics Society

2,391

1,043

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“…[28][29][30] This study is also a component of "ASPREE-D," which explores the potential of aspirin to prevent the onset of depression in the aged. This prevalence study is a substudy of a larger investigation, known as the ASPirin in Reducing Events in the Elderly (ASPREE) study, which is a randomized double-blind placebocontrolled trial examining the efficacy of low-dose aspirin on extending disability-free and dementia-free life in a healthy older population.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of depressive symptoms and its associated factors among healthy community‐dwelling older adults living in Australia and the United States

Mohebbi

Agustini

Woods

et al. 2019

Int J Geriat Psychiatry

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Objective This study was conducted to estimate prevalence rates and factors associated with depressive symptoms indexed by the Centre for Epidemiological Studies‐Depression (CES‐D‐10) score in a large sample of community‐dwelling healthy older adults from Australia and the United States. Convergent and divergent validity of the CES‐D‐10 were also examined. Methods A total of 19 114 individuals aged greater than or equal to 65 years old were enrolled from a primary prevention clinical trial. Depressive symptoms were classified using the CES‐D‐10 score greater than or equal to 8 and greater than or equal to 10. Gender‐specific prevalence for subgroups according to sociodemographic characteristics were reported, and factors associated with depressive symptoms were estimated. Results The overall prevalence rates of depressive symptoms were 9.8%, 95% CI, 8.5‐11.2 and 5.0%, 95% CI, 4.0‐6.0, according to the CES‐D‐10 score greater than or equal to 8 and greater than or equal to 10, respectively. Depressive symptoms were more common in women, individuals with less than 12 years of education, those living alone or in a residential care, ethnic minorities, current smokers, and former alcohol users. Convergent and divergent validities of the CES‐D‐10 were confirmed by observing strong negative association with the SF‐12 mental health component and a modest negative association with SF‐12 physical component, respectively. Conclusions This study reports the prevalence of depressive symptoms in Australian and US community‐dwelling healthy older populations. These findings emphasize the high burden of the condition and factors associated with depressive symptoms, to better inform clinicians and help with early detection and treatment of depression in this age group.

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“…P values were calculated using a paired t-test between the values recorded at the baseline and after treatment. 43 These results suggest that the benefits of aspirin use should be balanced by the bleeding risk. reduce cardiovascular events.…”

Section: Adverse Eventsmentioning

confidence: 98%

Effect of cilostazol, a phosphodiesterase‐3 inhibitor, on coronary artery stenosis and plaque characteristics in patients with type 2 diabetes: ESCAPE study

Lee

Chun

et al. 2019

Diabetes Obesity Metabolism

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Aim: To perform a prospective study to evaluate the effect of cilostazol (CTZ) compared with aspirin (acetylsalicylic acid; ASA) in Korean people with diabetes and subclinical coronary atherosclerosis.Materials and methods: A total of 100 people with diabetes who had mild to moderate coronary atherosclerosis, assessed by coronary computed tomographic angiography (CCTA), were randomly assigned to either 200 mg/d CTZ or 100 mg/d ASA (n = 50 each group). The primary outcome was change in coronary artery stenosis assessed by CCTA after 12 months of treatment. Secondary outcomes included changes in plaque composition, coronary artery calcium score and cardiac markers.Results: The mean age, body mass index and glycated haemoglobin concentration were 61.5 years, 25.0 kg/m 2 and 56.8 mmol/mol, respectively, and were well matched between the two groups. Coronary artery stenosis decreased in the CTZ group (from 44.0 ± 2.1% to 40.4 ± 2.5%) but remained unchanged in the ASA group (from 38.9 ± 2.1% to 40.6 ± 2.1%). In the CTZ group, the non-calcified portion of plaques decreased significantly (from 20.6 ± 3.0 to 17.3 ± 3.0 mm 3 ), whereas it did not change significantly in the ASA group (15.2 ± 2.8 vs 16.6 ± 2.9 mm 3 ). Increases in HDL cholesterol, decreases in triglycerides, liver enzyme and high-sensitivity C-reactive protein levels, and reductions in abdominal visceral fat area and insulin resistance were observed only in the CTZ group.Conclusion: CTZ treatment for 12 months decreased coronary artery stenosis and the noncalcified plaque component. These results suggest that CTZ treatment may be an option for preventing the progression of coronary atherosclerosis in people with diabetes.

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Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly

Cited by 824 publications

References 51 publications

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults

Prevalence of depressive symptoms and its associated factors among healthy community‐dwelling older adults living in Australia and the United States

Effect of cilostazol, a phosphodiesterase‐3 inhibitor, on coronary artery stenosis and plaque characteristics in patients with type 2 diabetes: ESCAPE study

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