The New England journal of medicine
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Randomized Controlled Trial Multicenter Study
Effect of Aspirin on Disability-free Survival in the Healthy Elderly.
Daily low-dose aspirin does not improve disability-free survival in the healthy elderly.
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Randomized Controlled Trial Multicenter Study
Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus.
Increased intake of n-3 fatty acids has been associated with a reduced risk of cardiovascular disease in observational studies, but this finding has not been confirmed in randomized trials. It remains unclear whether n-3 (also called omega-3) fatty acid supplementation has cardiovascular benefit in patients with diabetes mellitus. ⋯ Among patients with diabetes without evidence of cardiovascular disease, there was no significant difference in the risk of serious vascular events between those who were assigned to receive n-3 fatty acid supplementation and those who were assigned to receive placebo. (Funded by the British Heart Foundation and others; Current Controlled Trials number, ISRCTN60635500 ; ClinicalTrials.gov number, NCT00135226 .).
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Randomized Controlled Trial Multicenter Study
Effect of Aspirin on All-Cause Mortality in the Healthy Elderly.
Daily low-dose aspirin does not reduce all-cause mortality in the healthy elderly.
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Randomized Controlled Trial Multicenter Study
Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus.
Although daily low-dose aspirin reduces vascular events in those with diabetes but no cardiovascular history, it does this at the expense of major hemorrhage risk.
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Randomized Controlled Trial Multicenter Study
Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly.
What's the big deal?
Low-dose daily aspirin is one of the most common drugs taken for cardiovascular disease prophylaxis. Although it's role in secondary prevention is well established, until now it's use for primary prevention in the fit and healthy was controversial – even though it was widely taken by patients and their family doctors alike!
What did they do?
The ASPREE trial (Aspirin in Reducing Events in the Elderly) enrolled 19,114 across the U.S. and Australia, randomizing to 100mg daily aspirin or placebo. Participants were 56% women, median age of 74 and had median follow-up for almost 5 years.
What did they find?
Aspirin did NOT improve either disease-free survival OR reduce cardiovascular disease, although it did increase risk of major hemorrhage. Similarly no benefit was seen for all-cause mortality (in fact, a surprising increase crept in...).
The one group that did see a drop in cardiovascular events were diabetics with no previous cardiovascualr history but who suffered a counteracting increase of major hemorrhage.
But... this study specifically targeted the elderly, who suffer higher rates of antiplatelet-related hemorrhage. Modest benefits have previously been reported in a recently updated meta-analysis though again with a simultaneous increase in major and intracranial bleeding.
Final word... daily aspirin likely causes net harm in the healthy elderly.
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