Effect of Low-Dose Aspirin Versus Placebo on Incidence of Anemia in the Elderly : A Secondary Analysis of the Aspirin in Reducing Events in the Elderly Trial.
Journal
Annals of internal medicine
ISSN: 1539-3704
Titre abrégé: Ann Intern Med
Pays: United States
ID NLM: 0372351
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
medline:
19
7
2023
pubmed:
19
6
2023
entrez:
19
6
2023
Statut:
ppublish
Résumé
Daily low-dose aspirin increases major bleeding; however, few studies have investigated its effect on iron deficiency and anemia. To investigate the effect of low-dose aspirin on incident anemia, hemoglobin, and serum ferritin concentrations. Post hoc analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial. (ClinicalTrials.gov: NCT01038583). Primary/community care in Australia and the United States. Community-dwelling persons aged 70 years or older (≥65 years for Black persons and Hispanic persons). 100 mg of aspirin daily or placebo. Hemoglobin concentration was measured annually in all participants. Ferritin was measured at baseline and 3 years after random assignment in a large subset. 19 114 persons were randomly assigned. Anemia incidence in the aspirin and placebo groups was 51.2 events and 42.9 events per 1000 person-years, respectively (hazard ratio, 1.20 [95% CI, 1.12 to 1.29]). Hemoglobin concentrations declined by 3.6 g/L per 5 years in the placebo group and the aspirin group experienced a steeper decline by 0.6 g/L per 5 years (CI, 0.3 to 1.0 g/L). In 7139 participants with ferritin measures at baseline and year 3, the aspirin group had greater prevalence than placebo of ferritin levels less than 45 µg/L at year 3 (465 [13%] vs. 350 [9.8%]) and greater overall decline in ferritin by 11.5% (CI, 9.3% to 13.7%) compared with placebo. A sensitivity analysis quantifying the effect of aspirin in the absence of major bleeding produced similar results. Hemoglobin was measured annually. No data were available on causes of anemia. Low-dose aspirin increased incident anemia and decline in ferritin in otherwise healthy older adults, independent of major bleeding. Periodic monitoring of hemoglobin should be considered in older persons on aspirin. National Institutes of Health and Australian National Health and Medical Research Council.
Sections du résumé
BACKGROUND
Daily low-dose aspirin increases major bleeding; however, few studies have investigated its effect on iron deficiency and anemia.
OBJECTIVE
To investigate the effect of low-dose aspirin on incident anemia, hemoglobin, and serum ferritin concentrations.
DESIGN
Post hoc analysis of the ASPREE (ASPirin in Reducing Events in the Elderly) randomized controlled trial. (ClinicalTrials.gov: NCT01038583).
SETTING
Primary/community care in Australia and the United States.
PARTICIPANTS
Community-dwelling persons aged 70 years or older (≥65 years for Black persons and Hispanic persons).
INTERVENTION
100 mg of aspirin daily or placebo.
MEASUREMENTS
Hemoglobin concentration was measured annually in all participants. Ferritin was measured at baseline and 3 years after random assignment in a large subset.
RESULTS
19 114 persons were randomly assigned. Anemia incidence in the aspirin and placebo groups was 51.2 events and 42.9 events per 1000 person-years, respectively (hazard ratio, 1.20 [95% CI, 1.12 to 1.29]). Hemoglobin concentrations declined by 3.6 g/L per 5 years in the placebo group and the aspirin group experienced a steeper decline by 0.6 g/L per 5 years (CI, 0.3 to 1.0 g/L). In 7139 participants with ferritin measures at baseline and year 3, the aspirin group had greater prevalence than placebo of ferritin levels less than 45 µg/L at year 3 (465 [13%] vs. 350 [9.8%]) and greater overall decline in ferritin by 11.5% (CI, 9.3% to 13.7%) compared with placebo. A sensitivity analysis quantifying the effect of aspirin in the absence of major bleeding produced similar results.
LIMITATIONS
Hemoglobin was measured annually. No data were available on causes of anemia.
CONCLUSION
Low-dose aspirin increased incident anemia and decline in ferritin in otherwise healthy older adults, independent of major bleeding. Periodic monitoring of hemoglobin should be considered in older persons on aspirin.
PRIMARY FUNDING SOURCE
National Institutes of Health and Australian National Health and Medical Research Council.
Substances chimiques
Aspirin
R16CO5Y76E
Ferritins
9007-73-2
Hemoglobins
0
Banques de données
ClinicalTrials.gov
['NCT01038583']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
913-921Subventions
Organisme : NIA NIH HHS
ID : U01 AG029824
Pays : United States
Organisme : NIA NIH HHS
ID : U19 AG062682
Pays : United States
Commentaires et corrections
Type : ErratumIn
Type : ErratumIn
Type : CommentIn