Effect of Aspirin on Disability-free Survival in the Healthy Elderly. NEJM. 2018. JJ McNeil and ASPREE Investigator group

BACKGROUND

Information on the use of aspirin to increase healthy independent life span in older persons is limited. Whether 5 years of daily low-dose aspirin therapy would extend disability-free life in healthy seniors is unclear.

METHODS

From 2010 through 2014, we enrolled community-dwelling persons in Australia and the United States who were 70 years of age or older (or 65 years of age among blacks and Hispanics in the United States) and did not have cardiovascular disease, dementia, or physical disability. Participants were randomly assigned to receive 100 mg per day of enteric-coated aspirin or placebo orally. The primary end point was a composite of death, dementia, or persistent physical disability. Secondary end points reported in this article included the individual components of the primary end point and major haemorrhage.

RESULTS

A total of 19,114 persons with a median age of 74 years were enrolled, of whom 9525 were randomly assigned to receive aspirin and 9589 to receive placebo. A total of 56.4% of the participants were women, 8.7% were non-white, and 11.0% reported previous regular aspirin use. The trial was terminated at a median of 4.7 years of follow-up after a determination was made that there would be no benefit with continued aspirin use with regard to the primary end point. The rate of the composite of death, dementia, or persistent physical disability was 21.5 events per 1000 person-years in the aspirin group and 21.2 per 1000 person-years in the placebo group (hazard ratio, 1.01; 95% confidence interval [CI], 0.92 to 1.11). The rate of adherence to the assigned intervention was 62.1% in the aspirin group and 64.1% in the placebo group in the final year of trial participation. Differences between the aspirin group and the placebo group were not substantial with regard to the secondary individual end points of death from any cause (12.7 events per 1000 person-years in the aspirin group and 11.1 events per 1000 person-years in the placebo group), dementia, or persistent physical disability. The rate of major haemorrhage was higher in the aspirin group than in the placebo group (3.8% vs. 2.8%, hazard ratio, 1.38, 95% CI 1.18 to 1.62).

CONCLUSIONS

Aspirin use in healthy elderly persons did not prolong disability-free survival over a period of 5 years but led to a higher rate of major haemorrhage than placebo.

(Funded by the National Institute on Aging and others; ASPREE ClinicalTrials.gov number,NCT01038583.)

In the ASPREE trial they compared the effectiveness of aspirin with a placebo. If no difference in the outcome is observed despite the fact that, in truth, the aspirin is superior. Then the failure to detect a benefit for aspirin is best described as

Select one:

A.

Type I error

B.

Placebo effect

C.

Type II error

D.

Observer bias