Long-term Aspirin Use and Mortality in Women | Anticoagulation | JAMA Internal Medicine | JAMA Network
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1.
Anderson  RNSmith  BL Deaths: leading causes for 2002.  Natl Vital Stat Rep 2005;531- 89PubMedGoogle Scholar
2.
Steering Committee of the Physicians' Health Study Research Group, Final report on the aspirin component of the ongoing Physicians' Health Study.  N Engl J Med 1989;321129- 135PubMedGoogle ScholarCrossref
3.
Medical Research Council's General Practice Research Framework, Thrombosis prevention trial: randomised trial of low-intensity oral anticoagulation with warfarin and low-dose aspirin in the primary prevention of ischaemic heart disease in men at increased risk.  Lancet 1998;351233- 241PubMedGoogle ScholarCrossref
4.
Baron  JACole  BFSandler  RS  et al.  A randomized trial of aspirin to prevent colorectal adenomas.  N Engl J Med 2003;348891- 899PubMedGoogle ScholarCrossref
5.
Sandler  RSHalabi  SBaron  JA  et al.  A randomized trial of aspirin to prevent colorectal adenomas in patients with previous colorectal cancer.  N Engl J Med 2003;348883- 890[published correction appears in N Engl J Med. 2003;348:1939]PubMedGoogle ScholarCrossref
6.
Benamouzig  RDeyra  JMartin  A  et al.  Daily soluble aspirin and prevention of colorectal adenoma recurrence: one-year results of the APACC trial.  Gastroenterology 2003;125328- 336PubMedGoogle ScholarCrossref
7.
Antithrombotic Trialists' Collaboration, Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients.  BMJ 2002;32471- 86[published correction appears in BMJ. 2002;324:141]PubMedGoogle ScholarCrossref
8.
Ridker  PMCook  NRLee  IM  et al.  A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women.  N Engl J Med 2005;3521293- 1304PubMedGoogle ScholarCrossref
9.
Cook  NRLee  IMGaziano  JM  et al.  Low-dose aspirin in the primary prevention of cancer: the Women's Health Study; a randomized controlled trial.  JAMA 2005;29447- 55PubMedGoogle ScholarCrossref
10.
Manson  JEStampfer  MJColditz  GA  et al.  A prospective study of aspirin use and primary prevention of cardiovascular disease in women.  JAMA 1991;266521- 527PubMedGoogle ScholarCrossref
11.
Willett  WCSampson  LStampfer  MJ  et al.  Reproducibility and validity of a semiquantitative food frequency questionnaire.  Am J Epidemiol 1985;12251- 65PubMedGoogle Scholar
12.
Stampfer  MJWillett  WCSpeizer  FE  et al.  Test of the National Death Index.  Am J Epidemiol 1984;119837- 839PubMedGoogle Scholar
13.
Rich-Edwards  JWCorsano  KAStampfer  MJ Test of the National Death Index and Equifax Nationwide Death Search.  Am J Epidemiol 1994;1401016- 1019PubMedGoogle Scholar
14.
Iso  HHennekens  CHStampfer  MJ  et al.  Prospective study of aspirin use and risk of stroke in women.  Stroke 1999;301764- 1771PubMedGoogle ScholarCrossref
15.
Colditz  GAHankinson  SEHunter  DJ  et al.  The use of estrogens and progestins and the risk of breast cancer in postmenopausal women.  N Engl J Med 1995;3321589- 1593PubMedGoogle ScholarCrossref
16.
Giovannucci  EEgan  KMHunter  DJ  et al.  Aspirin and the risk of colorectal cancer in women.  N Engl J Med 1995;333609- 614PubMedGoogle ScholarCrossref
17.
Chan  ATGiovannucci  ELSchernhammer  ES  et al.  A prospective study of aspirin use and the risk of colorectal adenoma.  Ann Intern Med 2004;140157- 166PubMedGoogle ScholarCrossref
18.
Chan  ATGiovannucci  ELMeyerhardt  JASchernhammer  ESCurhan  GCFuchs  CS Long-term use of aspirin and nonsteroidal anti-inflammatory drugs and risk of colorectal cancer.  JAMA 2005;294914- 923PubMedGoogle ScholarCrossref
19.
Curhan  GCKnight  ELRosner  BHankinson  SEStampfer  MJ Lifetime nonnarcotic analgesic use and decline in renal function in women.  Arch Intern Med 2004;1641519- 1524PubMedGoogle ScholarCrossref
20.
Missmer  SAEliassen  AHBarbieri  RLHankinson  SE Endogenous estrogen, androgen, and progesterone concentrations and breast cancer risk among postmenopausal women.  J Natl Cancer Inst 2004;961856- 1865PubMedGoogle ScholarCrossref
21.
Hu  FBWillett  WCLi  TStampfer  MJColditz  GAManson  JE Adiposity as compared with physical activity in predicting mortality among women.  N Engl J Med 2004;3512694- 2703PubMedGoogle ScholarCrossref
22.
Manson  JEStampfer  MJHennekens  CHWillett  WC Body weight and longevity: a reassessment.  JAMA 1987;257353- 358PubMedGoogle ScholarCrossref
23.
Hosmer  DWLemeshow  S Applied Logistic Regression. 2nd ed. New York, NY John Wiley & Sons Inc2000;
24.
Fuchs  CSStampfer  MJColditz  GA  et al.  Alcohol consumption and mortality among women.  N Engl J Med 1995;3321245- 1250[published correction appears in N Engl J Med. 1997;336:523]PubMedGoogle ScholarCrossref
25.
Lee  SKawachi  IBerkman  LFGrodstein  F Education, other socioeconomic indicators, and cognitive function.  Am J Epidemiol 2003;157712- 720PubMedGoogle ScholarCrossref
26.
Shacter  EWeitzman  SA Chronic inflammation and cancer.  Oncology (Williston Park) 2002;16217- 226229- 232PubMedGoogle Scholar
27.
Erlinger  TPPlatz  EARifai  NHelzlsouer  KJ C-reactive protein and the risk of incident colorectal cancer.  JAMA 2004;291585- 590PubMedGoogle ScholarCrossref
28.
Colangelo  LAGapstur  SMGann  PHDyer  ARLiu  K Colorectal cancer mortality and factors related to the insulin resistance syndrome.  Cancer Epidemiol Biomarkers Prev 2002;11385- 391PubMedGoogle Scholar
29.
Awtry  EHLoscalzo  J Aspirin.  Circulation 2000;1011206- 1218PubMedGoogle ScholarCrossref
30.
Thun  MJ Beyond willow bark: aspirin in the prevention of chronic disease.  Epidemiology 2000;11371- 374PubMedGoogle ScholarCrossref
31.
Patrono  CGarcia Rodriguez  LALandolfi  RBaigent  C Low-dose aspirin for the prevention of atherothrombosis.  N Engl J Med 2005;3532373- 2383PubMedGoogle ScholarCrossref
32.
Thun  MJHenley  SJPatrono  C Nonsteroidal anti-inflammatory drugs as anticancer agents: mechanistic, pharmacologic, and clinical issues.  J Natl Cancer Inst 2002;94252- 266PubMedGoogle ScholarCrossref
33.
Leor  JReicher-Reiss  HGoldbourt  U  et al.  Aspirin and mortality in patients treated with angiotensin-converting enzyme inhibitors: a cohort study of 11 575 patients with coronary artery disease.  J Am Coll Cardiol 1999;331920- 1925PubMedGoogle ScholarCrossref
34.
Harpaz  DBenderly  MGoldbourt  UKishon  YBehar  SIsraeli BIP Study Group, Effect of aspirin on mortality in women with symptomatic or silent myocardial ischemia.  Am J Cardiol 1996;781215- 1219PubMedGoogle ScholarCrossref
35.
Harpaz  DGottlieb  SGraff  E  et al. Israeli Bezafibrate Infarction Prevention Study Group, Effects of aspirin treatment on survival in non–insulin-dependent diabetic patients with coronary artery disease.  Am J Med 1998;105494- 499PubMedGoogle ScholarCrossref
36.
Gum  PAThamilarasan  MWatanabe  JBlackstone  EHLauer  MS Aspirin use and all-cause mortality among patients being evaluated for known or suspected coronary artery disease: a propensity analysis.  JAMA 2001;2861187- 1194PubMedGoogle ScholarCrossref
37.
 Aspirin Myocardial Infarction Study Research Group. The Aspirin Myocardial Infarction Study: final results.  Circulation 1980;62 (pt 2)V79- V84PubMedGoogle Scholar
38.
Peto  RGray  RCollins  R  et al.  Randomised trial of prophylactic daily aspirin in British male doctors.  BMJ 1988;296313- 316PubMedGoogle ScholarCrossref
39.
Cook  NRHebert  PRManson  JEBuring  JEHennekens  CH Self-selected posttrial aspirin use and subsequent cardiovascular disease and mortality in the Physicians' Health Study.  Arch Intern Med 2000;160921- 928PubMedGoogle ScholarCrossref
40.
Ratnasinghe  LDGraubard  BIKahle  LTangrea  JATaylor  PRHawk  E Aspirin use and mortality from cancer in a prospective cohort study.  Anticancer Res 2004;243177- 3184PubMedGoogle Scholar
41.
Berger  JSRoncaglioni  MCAvanzini  FPangrazzi  ITognoni  GBrown  DL Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials.  JAMA 2006;295306- 313PubMedGoogle ScholarCrossref
42.
Hansson  LZanchetti  ACarruthers  SG  et al. HOT Study Group, Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial.  Lancet 1998;3511755- 1762PubMedGoogle ScholarCrossref
43.
Kjeldsen  SEKolloch  RELeonetti  G  et al.  Influence of gender and age on preventing cardiovascular disease by antihypertensive treatment and acetylsalicylic acid: the HOT study; Hypertension Optimal Treatment.  J Hypertens 2000;18629- 642PubMedGoogle ScholarCrossref
44.
de Gaetano  GCollaborative Group of the Primary Prevention Project, Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice.  Lancet 2001;35789- 95[published correction appears in Lancet. 2001;357:1134]PubMedGoogle ScholarCrossref
45.
Dannenberg  AJLippman  SMMann  JRSubbaramaiah  KDuBois  RN Cyclooxygenase-2 and epidermal growth factor receptor: pharmacologic targets for chemoprevention.  J Clin Oncol 2005;23254- 266PubMedGoogle ScholarCrossref
46.
Brown  JRDuBois  RN COX-2: a molecular target for colorectal cancer prevention.  J Clin Oncol 2005;232840- 2855PubMedGoogle ScholarCrossref
47.
Thun  MJNamboodiri  MMHeath  CW  Jr Aspirin use and reduced risk of fatal colon cancer.  N Engl J Med 1991;3251593- 1596PubMedGoogle ScholarCrossref
48.
Thun  MJNamboodiri  MMCalle  EEFlanders  WDHeath  CW  Jr Aspirin use and risk of fatal cancer.  Cancer Res 1993;531322- 1327PubMedGoogle Scholar
49.
Harris  REChlebowski  RTJackson  RD  et al.  Breast cancer and nonsteroidal anti-inflammatory drugs: prospective results from the Women's Health Initiative.  Cancer Res 2003;636096- 6101PubMedGoogle Scholar
Original Investigation
March 26, 2007

Long-term Aspirin Use and Mortality in Women

Author Affiliations

Author Affiliations: Gastrointestinal Unit, Massachusetts General Hospital and Harvard Medical School (Dr Chan); Division of Preventive Medicine (Dr Manson) and Channing Laboratory (Drs Chan, Manson, Feskanich, Stampfer, Colditz, and Fuchs), Department of Medicine, Brigham and Women's Hospital and Harvard Medical School; Department of Epidemiology (Drs Manson, Stampfer, and Colditz), Harvard School of Public Health; Department of Medical Oncology, Dana-Farber Cancer Institute (Dr Fuchs), Boston, Mass.

Arch Intern Med. 2007;167(6):562-572. doi:10.1001/archinte.167.6.562
Abstract

Background  The influence of long-term use of aspirin on total mortality in women remains uncertain.

Methods  We conducted a prospective, nested, case-control study of 79 439 women enrolled in the Nurses' Health Study who had no history of cardiovascular disease or cancer. Women provided data on medication use biennially since 1980. We assessed relative risk (RR) of death according to aspirin use before diagnosis of incident cardiovascular disease or cancer and during the corresponding period for each control subject.

Results  During 24 years, we documented 9477 deaths from all causes. In women who reported current aspirin use, the multivariate RR of death from all causes was 0.75 (95% confidence interval, 0.71-0.81) compared with women who never used aspirin regularly. The risk reduction was more apparent for death from cardiovascular disease (RR, 0.62; 95% confidence interval, 0.55-0.71) than for death from cancer (RR, 0.88; 95% confidence interval, 0.81-0.96). Use of aspirin for 1 to 5 years was associated with significant reductions in cardiovascular mortality (RR, 0.75; 95% confidence interval, 0.61-0.92). In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use (Plinear trend = .005). The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants (Pinteraction<.001) and those with more cardiac risk factors (Pinteraction = .02).

Conclusions  In women, low to moderate doses of aspirin are associated with significantly lower risk of all-cause mortality, particularly in older women and those with cardiac risk factors. A significant benefit is evident within 5 years for cardiovascular disease, whereas a modest benefit for cancer is not apparent until after 10 years of use.

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