The New England journal of medicine
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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.
pearl -
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.
pearl -
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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Randomized Controlled Trial Multicenter Study
Effect of Aspirin on Disability-free Survival in the Healthy Elderly.
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Randomized Controlled Trial Multicenter Study
VX-445-Tezacaftor-Ivacaftor in Patients with Cystic Fibrosis and One or Two Phe508del Alleles.
VX-445 is a next-generation cystic fibrosis transmembrane conductance regulator (CFTR) corrector designed to restore Phe508del CFTR protein function in patients with cystic fibrosis when administered with tezacaftor and ivacaftor (VX-445-tezacaftor-ivacaftor). ⋯ The use of VX-445-tezacaftor-ivacaftor to target Phe508del CFTR protein resulted in increased CFTR function in vitro and translated to improvements in patients with cystic fibrosis with one or two Phe508del alleles. This approach has the potential to treat the underlying cause of cystic fibrosis in approximately 90% of patients. (Funded by Vertex Pharmaceuticals; VX16-445-001 ClinicalTrials.gov number, NCT03227471 ; and EudraCT number, 2017-000797-11 .).