ASPREE trial — ASPirin in Reducing Events in the Elderly
A recent study using data from the significant ASPREE trial has revealed a 20% heightened likelihood of anaemia in certain older adults, primarily those aged 70 years or above, due to prolonged daily aspirin usage.
The ASPREE-Anaemia sub-study, a part of the larger ASPREE trial, offers insights that could assist general practitioners in identifying elderly patients more susceptible to anaemia. This identification may enable them to benefit from regular monitoring to detect the development of this condition.
Anaemia frequently affects older adults, potentially impacting their overall functionality and leading to increased fatigue, disabilities, depressive symptoms, and cognitive issues. Notably, approximately one third of anaemia cases in older adults have unknown origins.
The research, featured in the Annals of Internal Medicine, tracked 18,153 initially healthy older individuals in the USA and Australia, monitoring occurrences of anaemia over an average period of 4.7 years.
It was observed that the likelihood of experiencing anaemia was 20% higher among those in the aspirin group compared to those in the placebo group.
In addition to the elevated risk of anaemia, blood examinations uncovered a swifter decline in haemoglobin levels (a vital oxygen-carrying protein found in red blood cells) and reduced levels of ferritin (a protein responsible for iron transportation) in the aspirin group in contrast to the placebo group.
This comprehensive investigation represents the largest examination of anaemia in the elderly and formed part of the randomised controlled ASPREE trial (ASPirin in Reducing Events in the Elderly). In this trial, half of the participants received a placebo while the other half took a daily low dose (100mg) of aspirin.
Throughout the trial’s duration, 18% of individuals in the aspirin group and 15% in the placebo group developed anaemia.
Professor Zoe McQuilten, the lead author affiliated with Monash University’s School of Public Health and Preventive Medicine, highlighted the limited exploration in prior studies regarding the impact of prolonged aspirin usage on the gradual development of anaemia in older adults, despite bleeding being a recognised side effect of aspirin. She said, “The ASPREE-Anaemia sub-study provides a more comprehensive understanding of the added risk of developing anaemia with aspirin use, particularly affecting older adults with pre-existing conditions like kidney disease.”
Expressing the significance of the new findings, Prof. McQuilten noted that these data equip general practitioners with valuable insights into the potential risk of anaemia due to prolonged aspirin usage among their elderly patients. “Given the increased susceptibility of older adults to anaemia, physicians may now potentially identify those at higher risk of its development,” she said.
While emphasising the importance of seeking professional guidance, Prof. McQuilten advised patients to adhere to their doctor’s recommendations concerning daily aspirin usage. She cautioned against altering aspirin regimens without consulting healthcare providers, highlighting its importance for some older adults as a beneficial therapy in preventing recurring heart attacks or strokes.
Prof. McQuilten reassured that general practitioners possess the expertise to investigate and manage anaemia and low iron levels effectively.
In Australia, the measurement of ferritin levels was conducted using blood samples contributed to the ASPREE Biobank.
The ASPREE trial received primary funding from the National Institutes of Health in the USA, the Victorian Cancer Agency, Monash University, and the NHMRC in Australia. Notably, the ASPREE-Anaemia sub-study received partial funding from the Alfred Health Research Trust.
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