Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus

Bowman, Louise; Mafham, Marion; Wallendszus, Karl; Stevens, W. Grant; Buck, Georgina; Barton, Jill; Murphy, Kevin; Aung, Theingi; Haynes, Richard; Cox, Jolyon; Murawska, Aleksandra; Young, Allen J.; Lay, Michael; Chen, Fang; Sammons, Emily; Waters, Emma; Adler, Amanda I; Bodansky, Jonathan; Farmer, Andrew; McPherson, R. Kirk; Neil, Andrew; Simpson, David; Pető, Richárd; Baigent, Colin; Collins, Rory; Parish, Sarah; Armitage, Jane

doi:10.1056/nejmoa1804988

Cited by 864 publications

(489 citation statements)

References 23 publications

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“…The effect of aspirin on cancer incidence remains uncertain in randomized trials, 41 with two meta-analysis showing a protective effect 11,42 (30% reduction in cancer incidence 5 years after randomization, and with the benefit increasing with follow-up duration 11 ), other trials showing no effect, 9,41,43 and one trial with limited follow-up (5 years) showing a higher risk of cancer among aspirin users. 44 However, many trials mentioned above were not designed to study cancer as an outcome.…”

Section: Discussionmentioning

confidence: 99%

“…Until now, no randomized trial testing aspirin and included overall cancer as a prespecified outcome 8 showed a benefit on cancer incidence. [8][9][10] In contrast, post hoc analyses of randomized trials originally conducted to investigate the cardioprotective effect of LDA found a protective effect. 11 However, these trials were not initially designed to study cancer incidence as an outcome, and trial participants were highly selected, which limited extrapolation.…”

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confidence: 90%

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Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases

Ajrouche

Rycke

Dalichampt

et al. 2019

Pharmacoepidemiology and Drug

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Purpose The effect of chronic use of low‐dose aspirin (LDA) on overall cancer is still unclear owing to many controversial results and methodological limitations of studies. This study aimed to assess the effect of LDA use on overall cancer incidence among the French population. Methods We conducted a 10‐year historical cohort study using the permanent sample of the French national health care databases: the Système National des Données de Santé (SNDS). We used data for 111 025 individuals aged 50 to 80 years at study entry (January 1, 2006) without prevalent cancer or LDA use. Individuals were followed until the earliest of cancer incidence, death from any cause, exit from the database, or end of the study on December 31, 2015. We estimated the effect of LDA on cancer incidence by using a dynamic model to account for the competing risk of death in the presence of time‐dependent exposure and risk factors. Results LDA use was associated with reduced 10‐year risk of cancer (subdistribution hazard ratio [SHR] 0.81 [95% CI 0.77‐0.86]). The SHRs were 0.88 [0.82‐0.94] for men and 0.93 [0.85‐1.02] for women. Moreover, each additional year of LDA use was associated with reduced 10‐year risk of cancer (SHR 0.93 [0.92‐0.95]). LDA use was also associated with reduced 10‐year risk of death (SHR 0.86 [0.82‐0.91]). Conclusions This is the first population‐based study to demonstrate a protective effect of LDA on overall cancer incidence and to account for the main methodological issues of previous observational studies.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 90%

Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases

Ajrouche

Rycke

Dalichampt

et al. 2019

Pharmacoepidemiology and Drug

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“…32 We have now updated the same analysis following the publication of the latest trials on by aspirin, this meta -analysis basically confirms a substantial equivalence between the prevention of ischemic events and the increase in bleeding events, as reported in the ASCEND trial. 11 A further meta -analysis, with a particular focus on subgroups, has been published very recently, and has evaluated whether sex, concomitant statin treatment, diabetes, and smoking affected the benefit from aspirin. 31 The risk of MACEs seemed to be significantly reduced in men (RR, 0.89; 95% CI, 0.83-0.95), but not in women, possibly because of the greater cardiovascular risk among men.…”

Section: The Antithrombotic Trialists' Collaborationmentioning

confidence: 99%

Aspirin for primary cardiovascular prevention: why the wonder drug should not be precipitously dismissed

Aimo

Caterina

2020

Polish Archives of Internal Medicine

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Aspirin for primary cardiovascular prevention 121 is the increased risk of bleeding, ranging from trivial to potentially life-threatening. Assessing the balance between the reduction of MACE and the increase in bleeding is then crucial to establish whether aspirin should be prescribed for primary and secondary cardiovascular prevention. It is reasonable to assume that the higher the likelihood of cardiovascular events, the greater the expected absolute benefit from aspirin. We may also speculate that the benefit of aspirin therapy would have been more evident in the past decades when the risk for MACE was higher than now due to a much less intensive control of cardiovascular risk factors and less effective antithrombotic strategies. Yet, it is worth remembering that Introduction Cardiovascular disease is the leading cause of morbidity and mortality worldwide. This justifies the continuing search for optimal strategies in primary and secondary cardiovascular prevention. Primary cardiovascular prevention is the combined set of actions aimed at reducing the likelihood of symptomatic atherosclerotic disease or major adverse cardiovascular events (MACEs), while secondary prevention consists in limiting the probability of new events in patients with symptoms or prior MACE. Aspirin inhibits platelet activation elicited by acute plaque complications, thus blocking the very first step of the thrombogenic cascade. The drawback of aspirin therapy, as for any antithrombotic drug,

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“…The ASCEND trial [95] showed that, while aspirin did prevent vascular events, it also caused major bleedings. Within ASCEND, one in four of the patients took a PPI and increasing this ratio may reduce bleeding complications.…”

Section: Targeting the Right Patient Population For Primary Preventiomentioning

confidence: 99%

Highlights from the 2019 International Aspirin Foundation Scientific Conference, Rome, 28 June 2019: benefits and risks of antithrombotic therapy for cardiovascular disease prevention

Cattaneo¹,

Badimon²,

Agnelli³

et al. 2020

ecancer

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At the 2019 International Aspirin Foundation Scientific Conference 'Benefits and Risks of Antithrombotic Therapy for Cardiovascular Disease Prevention', held in Rome, Italy, international experts sought to discuss and debate the optimal antithrombotic strategy for the secondary prevention of cardiovascular disease (CVD) and to seek agreement around dosing and target populations for aspirin use in primary disease prevention. Getting the best evidence to support real-life decisions in the clinic can be complex, and individualising management in order to balance both the risks and benefits of different disease prevention strategies appears to be the best approach. It is hoped that future decisionmaking tools and biomarkers will help direct treatments at those most likely to benefit.

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Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus

Cited by 864 publications

References 23 publications

Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases

Reduced risk of cancer among low‐dose aspirin users: Data from French health care databases

Aspirin for primary cardiovascular prevention: why the wonder drug should not be precipitously dismissed

Highlights from the 2019 International Aspirin Foundation Scientific Conference, Rome, 28 June 2019: benefits and risks of antithrombotic therapy for cardiovascular disease prevention

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