Randomised trial of prophylactic daily aspirin in British male doctors

Abstract

A six year randomised trial was conducted among 5139 apparently healthy male doctors to see whether 500 mg aspirin daily would reduce the incidence of and mortality from stroke, myocardial infarction, or other vascular conditions. Though total mortality was 10% lower in the treated than control group, this difference was not statistically significant and chiefly involved diseases other than stroke or myocardial infarction. Likewise, there was no significant difference in the incidence of non-fatal myocardial infarction or stroke—indeed, disabling strokes were somewhat commoner among those allocated aspirin. The lower confidence limit for the effect of aspirin on non-fatal stroke or myocardial infarction, however, was a substantial 25% reduction. Migraine and certain types of musculoskeletal pain were reported significantly less often in the treated than control group, but as the control group was not given a placebo the relevance of these findings was difficult to assess. There was no apparent reduction in the incidence of cataract in the treated group. The lack of any apparent reduction in disabling stroke or vascular death contrasts with the established value of antiplatelet treatment after occlusive vascular disease.

Aspirin and lung cancer in women

“…The observed inverse association between long-term aspirin use and risk of lung cancer is in agreement with previous epidemiological studies suggesting that aspirin use could be associated with at least a moderately reduced risk of lung cancer (Peto et al, 1988;Schreinemachers and Everson, 1994). The observed association is also consistent with experimental evidence indicating that chemopreventive effects of aspirin and other NSAIDs could be mediated through the inhibition of COX-2 enzyme, which appears to be overexpressed in human lung carcinoma, particularly in nonsmall cell lung cancer (Hida et al, 1998;Wolff et al, 1998;Ochiai et al, 1999).…”

“…In a trial of aspirin among British physicians, there were fewer lung cancer deaths among aspirin users compared with nonusers (Peto et al, 1988). In two prospective studies, no overall association was observed between aspirin use and lung cancer, although when stratified by gender, regular aspirin use appeared to be inversely associated with lung cancer incidence (Paganini-Hill et al, 1989) and mortality (Thun et al, 1993) in women.…”

Use of NSAIDs, smoking and lung cancer risk

“…Of the remaining studies in which drug details were obtained before diagnosis, only three found significant inverse associations, two (but with overlapping data) with regular aspirin use (Schreinemachers and Everson, 1994;Ratnasinghe et al, 2004) and a third with other NSAID use (Hernández-Diaz and Rodriguez, 2007). The remaining studies, including the three low-dose aspirin randomised trials (Peto et al, 1988;Lee et al, 1995;Cook et al, 2007) and a Danish cohort study that we previously reported (Skriver et al, 2005), revealed a modest, nonsignificantly decreased risk, no appreciable effect or an increased risk, respectively. The observational studies relied either on self-reported use of NSAIDs or did not control sufficiently for smoking habits.…”

“…Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) used in relation to lung cancer have been investigated in at least 20 studies, including four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002;Muscat et al, 2003), fourteen cohort studies (Paganini-Hill et al, 1989;Thun et al, 1993;Schreinemachers and Everson, 1994;Langman et al, 2000;Akhmedkhanov et al, 2002;Friis et al, 2003;Holick et al, 2003;Sørensen et al, 2003;Ratnasinghe et al, 2004;Skriver et al, 2005;Hayes et al, 2006;Hernández-Diaz and Rodriguez, 2007;Jacobs et al, 2007;Wall et al, 2007) and three randomised trials (Peto et al, 1988;Lee et al, 1995;Cook et al, 2007). Significantly decreased risks were observed in three of the four hospital-based case -control studies (Rosenberg, 1995;Harris et al, 2002;Moysich et al, 2002), although all were based on selfreported drug use after diagnosis of cancer, raising the possibility of recall bias.…”

Risk of cancer in a large cohort of nonaspirin NSAID users: a population-based study

“…In contrast, a recent study reported an increased risk of pancreatic and prostate cancer among NSAID users (Langman et al, 2000). Data regarding the risk of lung, breast, and ovarian cancer among NSAID users are conflicting (Peto et al, 1988;Paganini-Hill et al, 1989;Schreinemachers and Everson, 1994;Egan et al, 1996;Harris et al, 1996Harris et al, , 1999Cramer et al, 1998;Akhmedkhanov et al, 2001;Moysich et al, 2001;Meier et al, 2002).…”