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Mehta RS, Kochar B, Zhou Z, Broder JC, Chung P, Yang K, Lockery J, Fravel M, Ryan J, Mahady S, Orchard SG, McNeil JJ, Murray A, Woods RL, Ernst ME, Chan AT. Association of Proton Pump Inhibitor Use With Incident Dementia and Cognitive Decline in Older Adults: A Prospective Cohort Study. Gastroenterology 2023; 165:564-572.e1. [PMID: 37315867 PMCID: PMC10527011 DOI: 10.1053/j.gastro.2023.05.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/02/2023] [Accepted: 05/12/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND & AIMS Prior studies have suggested that proton pump inhibitor (PPI) use is associated with increased risk of dementia; however, these have been limited by incomplete assessment of medication use and failure to account for confounders. Furthermore, prior studies have relied on claims-based diagnoses for dementia, which can lead to misclassification. We investigated the associations of PPI and histamine-2 receptor antagonist (H2RA) use with dementia and cognitive decline. METHODS We conducted a post hoc analysis of ASPirin in Reducing Events in the Elderly (ASPREE), a randomized trial of aspirin in the United States and Australia, including 18,934 community-based adults ≥65 years of all races/ethnicities. Baseline and recent PPI and H2RA use were determined according to review of medications during annual in-person study visits. Incident dementia was defined according to Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition, criteria. Secondary endpoints include cognitive impairment, no dementia (CIND) and changes in cognition. Associations of medication use with dementia and CIND outcomes were examined using Cox proportional hazards models. Changes in cognitive test scores were examined using linear mixed-effects models. RESULTS Baseline PPI use vs nonuse was not associated with incident dementia (multivariable hazard ratio, 0.88; 95% confidence interval, 0.72-1.08), CIND (multivariable hazard ratio, 1.00; 95% confidence interval, 0.92-1.09), or with changes in overall cognitive test scores over time (multivariable B, -0.002; standard error, 0.01; P = .85). Similarly, no associations were observed between H2RA use and all cognitive endpoints. CONCLUSIONS In adults ≥65 years of age, PPI and H2RA use were not associated with incident dementia, CIND, or decline in cognition over time. These data provide reassurance about the safety of long-term use of PPIs among older adults.
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Affiliation(s)
- Raaj S Mehta
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Bharati Kochar
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Jonathan C Broder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paget Chung
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Keming Yang
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michelle Fravel
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne Mahady
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne Murray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, Iowa; Department of Family Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.
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Cloud GC, Williamson JD, Thao LTP, Tran C, Eaton CB, Wolfe R, Nelson MR, Reid CM, Newman AB, Lockery J, Fitzgerald SM, Murray AM, Shah RC, Woods RL, Donnan GA, McNeil JJ. Low-Dose Aspirin and the Risk of Stroke and Intracerebral Bleeding in Healthy Older People: Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2325803. [PMID: 37494038 PMCID: PMC10372701 DOI: 10.1001/jamanetworkopen.2023.25803] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023] Open
Abstract
Importance Low-dose aspirin has been widely used for primary and secondary prevention of stroke. The balance between potential reduction of ischemic stroke events and increased intracranial bleeding has not been established in older individuals. Objective To establish the risks of ischemic stroke and intracranial bleeding among healthy older people receiving daily low-dose aspirin. Design, Setting, and Participants This secondary analysis of the Aspirin in Reducing Events in the Elderly (ASPREE) randomized, double-blind, placebo-controlled trial of daily low-dose aspirin was conducted among community-dwelling people living in Australia or the US. Participants were older adults free of symptomatic cardiovascular disease. Recruitment took place between 2010 and 2014, and participants were followed up for a median (IQR) of 4.7 (3.6-5.7) years. This analysis was completed from August 2021 to March 2023. Interventions Daily 100-mg enteric-coated aspirin or matching placebo. Main Outcomes and Measures Stroke and stroke etiology were predetermined secondary outcomes and are presented with a focus on prevention of initial stroke or intracranial bleeding event. Outcomes were assessed by review of medical records. Results Among 19 114 older adults (10 782 females [56.4%]; median [IQR] age, 74 [71.6-77.7] years), 9525 individuals received aspirin and 9589 individuals received placebo. Aspirin did not produce a statistically significant reduction in the incidence of ischemic stroke (hazard ratio [HR], 0.89; 95% CI, 0.71-1.11). However, a statistically significant increase in intracranial bleeding was observed among individuals assigned to aspirin (108 individuals [1.1%]) compared with those receiving placebo (79 individuals [0.8%]; HR, 1.38; 95% CI, 1.03-1.84). This occurred by an increase in a combination of subdural, extradural, and subarachnoid bleeding with aspirin compared with placebo (59 individuals [0.6%] vs 41 individuals [0.4%]; HR, 1.45; 95% CI, 0.98-2.16). Hemorrhagic stroke was recorded in 49 individuals (0.5%) assigned to aspirin compared with 37 individuals (0.4%) in the placebo group (HR, 1.33; 95% CI, 0.87-2.04). Conclusions and Relevance This study found a significant increase in intracranial bleeding with daily low-dose aspirin but no significant reduction of ischemic stroke. These findings may have particular relevance to older individuals prone to developing intracranial bleeding after head trauma. Trial Registration ISRCTN.org Identifier: ISRCTN83772183.
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Affiliation(s)
- Geoffrey C. Cloud
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Jeff D. Williamson
- Sticht Center for Healthy Aging and Alzheimer’s Prevention, Department of Internal Medicine, Section on Geriatric Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Le Thi Phuong Thao
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Cammie Tran
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Charles B. Eaton
- Center for Primary Care and Prevention, Brown University School of Public Health, Pawtucket, Rhode Island
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Anne B. Newman
- Department of Epidemiology Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sharyn M. Fitzgerald
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Anne M. Murray
- Department of Medicine, Geriatrics Division, Hennepin HealthCare and Berman Center for Clinical Research, Hennepin HealthCare Research Institute, Minneapolis, Minnesota
| | - Raj C. Shah
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Geoffrey A. Donnan
- Melbourne Brain Centre, University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Lockery J, Collyer T, Woods R, Orchard S, Murray A, Ernst M. POTENTIALLY INAPPROPRIATE MEDICATION USE INCREASES RISK OF INCIDENT DISABILITY IN HEALTHY OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9767009 DOI: 10.1093/geroni/igac059.2728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Efforts to minimize medication risks among older adults include avoidance of potentially inappropriate medications (PIMs). However, most PIMs research has focussed on aged or inpatient care, creating an evidence gap for community-dwelling older adults. To address this, we investigated the impact of PIMs use in the ASPREE clinical trial. Methods ASPREE enrolled 19,114 community-dwelling participants aged 70+ years (65+ if US minorities) without a history of major cardiovascular disease, cognitive impairment, and significant physical disability. PIMs was defined according to a modified 2019 AGS Beers Criteria. Cox proportional-hazards regression models were used to estimate the association between baseline PIMs exposure, and disability-free survival, death, disability, and hospitalization, with adjustment for comorbidities including frailty. Results At baseline, 7396 (39% of total) participants were prescribed at least one PIM. Compared with those unexposed, participants on a PIM at baseline were at an increased risk of persistent physical disability (Adjusted HR 1.47, 95%CI 1.21, 1.80) and hospitalization (Adjusted HR 1.26, 95%CI 1.20, 1.32), but had similar rates of disability free survival and death. These effects did not vary by polypharmacy status. PIMs exposure was associated with higher risk of disability followed by hospitalization (Adjusted HR 1.92, 95%CI 1.25, 2.96) as well as vice versa (Adjusted HR 1.54, 95%CI 1.15, 2.05). Conclusions: PIMs exposure is associated with increased risk of incident disability and hospitalization. Increased risk of disability prior to hospitalization suggests that PIMs use may start the disability cascade, emphasizing the importance of caution when prescribing PIMs for community-dwelling older adults.
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Affiliation(s)
| | - Taya Collyer
- Monash University, Melbourne, Victoria, Australia
| | - Robyn Woods
- Monash University, Melbourne, Victoria, Australia
| | | | - Anne Murray
- Hennepin Healthcare, Minneapolis, Minnesota, United States
| | - Michael Ernst
- The University of Iowa, Iowa City, Iowa, United States
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Ekram ARMS, Woods RL, Ryan J, Espinoza SE, Gilmartin-Thomas JF, Shah RC, Mehta R, Kochar B, Lowthian JA, Lockery J, Orchard S, Nelson M, Fravel MA, Liew D, Ernst ME. The association between polypharmacy, frailty and disability-free survival in community-dwelling healthy older individuals. Arch Gerontol Geriatr 2022; 101:104694. [PMID: 35349875 PMCID: PMC9437977 DOI: 10.1016/j.archger.2022.104694] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/11/2022] [Accepted: 03/22/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Polypharmacy and frailty are two common geriatric conditions. In community-dwelling healthy older adults, we examined whether polypharmacy is associated with frailty and affects disability-free survival (DFS), assessed as a composite of death, dementia, or persistent physical disability. METHODS We included 19,114 participants (median age 74.0 years, IQR: 6.1 years) from ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial. Frailty was assessed by a modified Fried phenotype and a deficit accumulation Frailty Index (FI). Polypharmacy was defined as concomitant use of five or more prescription medications. Multinomial logistic regression was used to examine the cross-sectional association between polypharmacy and frailty at base line, and Cox regression to determine the effect of polypharmacy and frailty on DFS over five years. RESULTS Individuals with polypharmacy (vs. <5 medications) were 55% more likely to be pre-frail (Relative Risk Ratio or RRR: 1.55; 95%Confidence Interval or CI:1.44, 1.68) and three times more likely to be frail (RRR: 3.34; 95%CI:2.64, 4.22) according to Fried phenotype. Frailty alone was associated with double risk of the composite outcome (Hazard ratio or HR: 2.16; 95%CI: 1.56, 2.99), but frail individuals using polypharmacy had a four-fold risk (HR: 4.24; 95%CI: 3.28, 5.47). Effect sizes were larger when frailty was assessed using the FI. CONCLUSION Polypharmacy was significantly associated with pre-frailty and frailty at baseline. Polypharmacy-exposed frailty increased the risk of reducing disability-free survival among older adults. Addressing polypharmacy in older people could ameliorate the impact of frailty on individuals' functional status, cognition and survival.
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5
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Orchard S, Broder J, Lockery J, Gibbs P, Espinoza S, Ernst M, Woods R, McNeil AJ. Associations between Metformin and Aspirin Use on Cancer Incidence and Mortality in Older Adults. Innov Aging 2021. [PMCID: PMC8681499 DOI: 10.1093/geroni/igab046.2339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Diabetes increases risk of malignancies, and this association increases with age. Metformin may protect against cancer development and progression, but results are mixed and limited to younger cohorts. We examined whether metformin, in the presence or absence of aspirin, reduces incident cancer and cancer-related mortality in older adults. ASPirin in Reducing Events in the Elderly (ASPREE) was a primary prevention trial of daily aspirin vs placebo which enrolled community-dwelling adults from Australia (70+ years) and the US (65+ years for minorities) followed for a median of 4.7 years. Invasive cancer was adjudicated by an expert panel. Cox proportional-hazards models, controlling for age at randomization and known cancer risk factors, were used to analyse the relationship between baseline metformin use, randomized treatment arm, cancer incidence (first in-trial cancer) and mortality. For participants with controlled diabetes, there was a significant reduction in cancer mortality in metformin users compared to nonusers (Adjusted [Adj] HR=0.24, 95%CI=0.07, 0.80), but not for cancer incidence (Adj HR=0.61, 95%CI=0.29, 1.27). For participants with uncontrolled diabetes, there was no significant difference in cancer incidence (Adj HR=0.95, 95%CI=0.66, 1.38) or mortality (Adj HR=1.18, 95%CI=0.62, 2.26) between metformin and non-metformin users. Uncontrolled diabetes, irrespective of metformin use, increased risk of cancer incidence and mortality compared to non-diabetics. Aspirin did not modify the effect of metformin on cancer incidence or mortality. Our findings show that metformin may have protective effects against cancer-related mortality for those older persons whose diabetes is well-controlled, and underscores the importance of diabetes control to minimise cancer risk.
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Affiliation(s)
| | | | | | - Peter Gibbs
- The Walter & Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
| | - Sara Espinoza
- University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
| | | | - Robyn Woods
- Monash University, Melbourne, Victoria, Australia
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6
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Orchard S, Lockery J, Gibbs P, Polehkina G, Wolfe R, Zalcberg J, Haydon A, McNeil J, Nelson M, Reid C, Kirpach B, Murray A, Woods R. 602Prevalence of cancer history and association with risk factors in a healthy older population. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden and association with known cancer risk factors in this population.
Methods
At enrolment (2010-2014), self-reported personal cancer history, cancer type and cancer risk factor data were sought from 19,114 participants (Australia, n = 16,703; U.S., n = 2,411). Participants were healthy and expected to survive 5 years.
Results
Of those reporting a prior cancer diagnosis (18% women, 22% men), women were diagnosed younger (16% vs 6% of diagnoses <50 years). Cancer prevalence increased with age. Prostate and breast cancer history were higher in U.S. participants; melanoma and colorectal cancer were higher in Australian participants. Cancer history prevalence was not associated with any common risk factors, but was associated with poor health ratings in men. Blood and breast cancer history was more common with past aspirin use.
Conclusions
Personal cancer history in healthy older ASPREE participants was as expected for the most common cancer types in the respective populations. The lack of alignment with known risk factors is attributable to survivor bias, driven by entry criteria, and to possible molecular differences in cancer between elderly and younger people.
Key messages
As the prevalence of cancer increases with age, the lack of alignment with known risk factors implies other factors play a significant role.
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Affiliation(s)
| | | | - Peter Gibbs
- Peter Macallum Cancer Foundation, Melbourne, Australia
| | | | | | | | | | | | - Mark Nelson
- Menzies Institute For Medical Research, University of Tasmania, Hobart, Australia
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Phyo AZZ, Ryan J, Gonzalez-Chica D, McNeil J, Woods R, Nelson M, Murray A, Lockery J, Gasevic D, Stocks N, Freak-Poli R. 226Health-related quality of life and all-cause mortality among older people: a prospective cohort study. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Health-related quality of life (HRQoL) is a measure of an individual’s self-perceived health status. Few studies have examined HRQoL as a risk factor for mortality. This study examined whether HRQoL predicts all-cause mortality in older community-dwelling individuals from Australia and the United States enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial, and if this association varies across gender.
Methods
The 19,106 persons aged 65–98 years and free of known major life-limiting disease, who completed the 12-item short form (SF-12) HRQoL at ASPREE-baseline (2010–2014) were followed prospectively until 2017 for all-cause mortality. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours, and clinical measures.
Results
There were 1,052 deaths over a median 4.7-year of follow-up, with 11.9 events per 1,000 person-years. A 10-unit increase in PCS was associated with a 17% decrease in all-cause mortality (95%CI: 0.77, 0.89). MCS was not associated with all-cause mortality. There was no evidence these associations were different between males and females (P-values for interaction: PCS 0.13 and MCS 0.44).
Conclusions
PCS, but not MCS, was inversely associated with all-cause mortality in this large cohort of healthy older individuals.
Key messages
Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the routine collection of Patient Reported Outcome Measures as a policy goal for the Australian health system.
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Affiliation(s)
- Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, United States
- Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, United States
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, United Kingdom
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
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8
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Riaz M, Huq A, Ryan J, Orchard SG, Tiller J, Lockery J, Woods RL, Wolfe R, Renton AE, Goate AM, Sebra R, Schadt E, Brodtmann A, Shah RC, Storey E, Murray AM, McNeil JJ, Lacaze P. Effect of APOE and a polygenic risk score on incident dementia and cognitive decline in a healthy older population. Aging Cell 2021; 20:e13384. [PMID: 34041846 PMCID: PMC8208779 DOI: 10.1111/acel.13384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 04/15/2021] [Accepted: 04/26/2021] [Indexed: 01/09/2023] Open
Abstract
Few studies have measured the effect of genetic factors on dementia and cognitive decline in healthy older individuals followed prospectively. We studied cumulative incidence of dementia and cognitive decline, stratified by APOE genotypes and polygenic risk score (PRS) tertiles, in 12,978 participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. At enrolment, participants had no history of diagnosed dementia, cardiovascular disease, physical disability or cognitive impairment. Dementia (adjudicated trial endpoint) and cognitive decline, defined as a >1.5 standard deviation decline in test score for either global cognition, episodic memory, language/executive function or psychomotor speed, versus baseline scores. Cumulative incidence for all‐cause dementia and cognitive decline was calculated with mortality as a competing event, stratified by APOE genotypes and tertiles of a PRS based on 23 common non‐APOE variants. During a median 4.5 years of follow‐up, 324 participants developed dementia, 503 died. Cumulative incidence of dementia to age 85 years was 7.4% in all participants, 12.6% in APOE ε3/ε4 and 26.6% in ε4/ε4. APOE ε4 heterozygosity/homozygosity was associated with a 2.5/6.3‐fold increased dementia risk and 1.4/1.8‐fold cognitive decline risk, versus ε3/ε3 (p < 0.001 for both). High PRS tertile was associated with a 1.4‐fold dementia risk versus low (CI 1.04–1.76, p = 0.02), but was not associated with cognitive decline (CI 0.96–1.22, p = 0.18). Incidence of dementia among healthy older individuals is low across all genotypes; however, APOE ε4 and high PRS increase relative risk. APOE ε4 is associated with cognitive decline, but PRS is not.
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Affiliation(s)
- Moeen Riaz
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Aamira Huq
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
- Department of Genomic Medicine Royal Melbourne Hospital University of Melbourne Melbourne Vic Australia
- Department of Medicine Royal Melbourne Hospital University of Melbourne Melbourne Vic Australia
| | - Joanne Ryan
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Suzanne G Orchard
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Jane Tiller
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Alan E. Renton
- Nash Family Department of Neuroscience and Ronald Loeb Center for Alzheimer’s Disease Icahn School of Medicine at Mount Sinai New York NY USA
- Departments of Neurology and Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - Alison M. Goate
- Nash Family Department of Neuroscience and Ronald Loeb Center for Alzheimer’s Disease Icahn School of Medicine at Mount Sinai New York NY USA
- Departments of Neurology and Genetics and Genomic Sciences Icahn School of Medicine at Mount Sinai New York NY USA
| | - Robert Sebra
- Department of Genetics and Genomic Sciences Icahn Institute for Data Science and Genomic Technology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Eric Schadt
- Department of Genetics and Genomic Sciences Icahn Institute for Data Science and Genomic Technology Icahn School of Medicine at Mount Sinai New York NY USA
| | - Amy Brodtmann
- Florey Institute of Neuroscience and Mental Health Melbourne Vic Australia
- Melbourne Dementia Research Centre University of Melbourne Melbourne Vic Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer's Disease Center Rush University Medical Center Chicago Illinois USA
| | - Elsdon Storey
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research Hennepin Healthcare Research Institute University of Minnesota Minneapolis MN USA
| | - John J. McNeil
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine School of Public Health and Preventive Medicine Monash University Melbourne Vic Australia
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Gilmartin-Thomas JFM, Forbes A, Liew D, McNeil JJ, Cicuttini FM, Owen AJ, Ernst ME, Nelson MR, Lockery J, Ward SA, Busija L. Evaluation of the Pain Impact Index for Community-Dwelling Older Adults Through the Application of Rasch Modelling. Pain Pract 2021; 21:501-512. [PMID: 33295122 PMCID: PMC8187294 DOI: 10.1111/papr.12980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/14/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Evaluate the Pain Impact Index, a simple, brief, easy-to-use, and novel tool to assess the impact of chronic pain in community-dwelling older adults. METHODS A Rasch modelling analysis was undertaken in Stata using a partial credit model suited to the Likert-type items that comprised the Index. The Index was evaluated for ordering of category thresholds, unidimensionality, overall fit to the Rasch model, measurement bias (Differential Item Functioning, DIF), targeting, and construct validity. RESULTS The four-item Pain Impact Index was self-completed by 6454 community-dwelling Australians who were aged at least 70 years and experienced pain on most days. Two items showed evidence of threshold disordering, and this was resolved by collapsing response categories (from 5 to 3) for all items. The rescored Index conformed to the unidimensionality assumption and had satisfactory fit with the Rasch model (analyses conducted on a reduced sample size to mitigate the potential for overpowering: n = 377, P > 0.0125, power > 77%). When considering uniform DIF, the most frequent sources of measurement bias were age, knee pain, and upper back pain. When considering nonuniform DIF, the most frequent source of measurement bias was knee pain. The Index had good ability to differentiate between respondents with different levels of pain impact and had highest measurement precision for respondents located around the average level of pain impact in the study sample. Both convergent and discriminant validity of the Index were supported. CONCLUSION The Pain Impact Index showed evidence of unidimensionality, was able to successfully differentiate between levels of pain impact, and had good evidence of construct validity.
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Affiliation(s)
- Julia F-M Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Andrew Forbes
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Alice J Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa City, Iowa, U.S.A
- Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, U.S.A
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Centre for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, New South Wales, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
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Gilmartin-Thomas JFM, Ernst ME, Nelson MR, Lockery J, Ward SA, Woods RL, Britt C, Murray A, Workman B, McNeil J. Musculoskeletal Pain Experienced on Most Days is a Common Accompaniment of Ageing amongst Community-Dwelling Older Australians: A Questionnaire-Based Study. J Aging Health 2020; 33:39-47. [PMID: 32912103 DOI: 10.1177/0898264320952914] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Objective: To describe the prevalence, location and impact of moderate to severe pain experienced on most days in community-dwelling older (≥70 years) adults who were ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial participants. Methods: Cross-sectional ASPREE Longitudinal Study of Older Persons (ALSOP) data were collected from self-reported questionnaires administered to 16,439 ASPREE participants. Results: Of 14,155 respondents, 41% of males (n = 2651/6475) and 50% of females (n = 3803/7680) reported experiencing pain on most days. One quarter of respondents reported experiencing pain on most days that was moderate or severe in intensity (n = 3560/14,155), commonly located in the lower back, knees and upper back. Of those reporting moderate or severe pain, 51% reported taking analgesic medication on most days (n = 1812/3560), almost one-third also reported regular interference with sleep (29%, n = 1024/3560), walking (35%, n = 1239/3560) and daily activities (41%, n = 1467/3560). Discussion: Lower back, knee or upper back pain is a common accompaniment of ageing.
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Affiliation(s)
- Julia F-M Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
| | - Michael E Ernst
- Carver College of Medicine, 4083The University of Iowa, IA, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia.,Menzies Institute for Medical Research, 3925University of Tasmania, Australia
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
| | - Anne Murray
- Berman Center for Outcomes & Clinical Research, Minneapolis, USA
| | - Barbara Workman
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, 2541Monash University, Australia
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Gilmartin-Thomas JF, Cicuttini FM, Owen AJ, Wolfe R, Ernst ME, Nelson MR, Lockery J, Woods RL, Britt C, Liew D, Murray A, Workman B, Ward SA, McNeil JJ. Moderate or severe low back pain is associated with body mass index amongst community-dwelling older Australians. Arch Gerontol Geriatr 2020; 91:104231. [PMID: 32861954 PMCID: PMC9588391 DOI: 10.1016/j.archger.2020.104231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/11/2020] [Accepted: 08/11/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Low back pain is prevalent in older populations and modifiable risk factors may include being overweight or obese. This study aimed to describe the prevalence and impact of moderate or severe low back pain in community-dwelling older adults and its association with body mass index (BMI). METHODS Cross-sectional study involving 16,439 Australians aged ≥70 years. Logistic regression was used to describe associations between the presence or absence of moderate or severe low back pain experienced on most days with BMI. Analyses were conducted separately for males and females, and controlled for age and depression at baseline. RESULTS Of 14,155 pain question respondents, 11 % of males (n = 710/6475) and 18 % of females (n = 1391/7680) reported moderate or severe low back pain (total 15 %, n = 2101/14,155). Of those reporting moderate or severe low back pain (n = 2101), 55 % reported taking pain-relieving medication regularly, and 29 % reported that the pain regularly interfered with sleep, 37 % with walking, and 47 % with day to day activities. When age and depression were controlled for, there was a statistically significant (p < 0.001) association between moderate or severe low back pain and being overweight (females: odds ratio OR = 1.50, 95 % confidence interval CI = 1.27-1.76) or obese (males: OR = 2.23, 95 %CI = 1.77-2.80 and females: OR = 2.91, 95 %CI = 2.48-3.42). CONCLUSION Moderate or severe low back pain is common, has a significant impact, and is associated with either an overweight or obese BMI among community-dwelling Australians aged ≥70 years.
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Affiliation(s)
- Julia Fm Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia
| | - Alice J Owen
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Michael E Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, Department of Family Medicine, Carver College of Medicine, The University of Iowa.
| | - Mark R Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia; Menzies Institute for Medical Research, University of Tasmania.
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Carlene Britt
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Danny Liew
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Anne Murray
- Berman Center for Outcomes & Clinical Research, Minneapolis.
| | - Barbara Workman
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
| | - Stephanie A Ward
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia; Centre for Healthy Brain Ageing, University of New South Wales.
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3004 Australia.
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Ryan J, Storey E, Murray A, Woods R, Chong T, Burns C, Williamson JD, Ward SA, Wolfe R, Lockery J, Orchard S, Reid C, Nelson M, McNeil J, Shah RC. P4-012: A RANDOMIZED CONTROLLED TRIAL OF THE EFFECT OF ASPIRIN VERSUS PLACEBO ON INCIDENT DEMENTIA AND PROBABLE ALZHEIMER'S DISEASE. Alzheimers Dement 2019. [DOI: 10.1016/j.jalz.2019.06.3671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Anne Murray
- Hennepin County Medical Center; Minneapolis MN USA
- The Berman Center for Outcomes and Clinical Research; Hennepin Healthcare Research Institute; Minneapolis MN USA
- University of Minnesota; Minneapolis MN USA
| | | | | | - Christine Burns
- Hennepin County Medical Center; Minneapolis MN USA
- Berman Center for Clinical Research; Minneapolis Medical Research Foundation; Minneapolis MN USA
| | | | - Stephanie Alison Ward
- Prince of Wales Hospital; Sydney NSW Australia
- Monash University; Melbourne VIC Australia
| | | | | | | | - Christopher Reid
- Monash University; Melbourne Australia
- School of Public Health; Curtin University; Perth Australia
| | | | | | - Raj C. Shah
- Rush Alzheimer's Disease Center; Chicago IL USA
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13
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Wolfe R, Murray AM, Woods RL, Kirpach B, Gilbertson D, Shah RC, Nelson MR, Reid CM, Ernst ME, Lockery J, Donnan GA, Williamson J, McNeil JJ. The aspirin in reducing events in the elderly trial: Statistical analysis plan. Int J Stroke 2017; 13:335-338. [PMID: 29111960 DOI: 10.1177/1747493017741383] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Rationale Aspirin has positive and negative effects on a number of age-related chronic conditions and there is uncertainty regarding its role in primary prevention in people aged 70 years and over. Aims To assess whether daily active treatment of 100 mg enteric-coated aspirin will extend the duration of disability-free life in healthy older participants. Design A double-blind, randomized, placebo-controlled primary prevention trial undertaken in Australia and the United States with careful adjudication of endpoints including stroke. Study outcome In Australia 16,703 individuals were recruited through general practices across five states and territories, and in the United States, 2411 participants were recruited through 34 clinical sites across the country. Follow-up of participants will finish at the end of 2017 with average follow-up exceeding 4.25 years per person. Discussion The statistical analysis plan for ASPREE, finalized after closure of recruitment but before the end of patient follow-up, outlines the primary analyses and a range of subgroup and sensitivity analyses. (International Standard Randomized Controlled Trial Number Register ISRCTN83772183 and clinicaltrials.gov Number NCT01038583).
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Affiliation(s)
- Rory Wolfe
- 1 161667 School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Anne M Murray
- 2 Hennepin County Medical Center, Berman Center for Outcomes and Clinical Research, 20298 Minneapolis Medical Research Foundation , Minneapolis, MN, USA.,3 Hennepin County Medical Center and University of Minnesota, Division of Geriatrics, Department of Medicine, Minneapolis, MN, USA
| | - Robyn L Woods
- 1 161667 School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Brenda Kirpach
- 2 Hennepin County Medical Center, Berman Center for Outcomes and Clinical Research, 20298 Minneapolis Medical Research Foundation , Minneapolis, MN, USA
| | - David Gilbertson
- 4 20298 Minneapolis Medical Research Foundation , Chronic Disease Research Group, Minneapolis, MN, USA
| | - Raj C Shah
- 5 Department of Family Medicine and Rush Alzheimer's Disease Center, 2468 Rush University Medical Center , Chicago, IL, USA
| | - Mark R Nelson
- 6 Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Christopher M Reid
- 1 161667 School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia.,7 School of Public Health, 161909 Curtin University , Perth, WA, Australia
| | - Michael E Ernst
- 8 Department of Pharmacy Practice and Science, College of Pharmacy and Department of Family Medicine, Carver College of Medicine, 4083 University of Iowa , Iowa City, IA, USA
| | - Jessica Lockery
- 1 161667 School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
| | - Geoffrey A Donnan
- 9 University of Melbourne, Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Jeff Williamson
- 10 Department of Internal Medicine, 12279 Wake Forest University School of Medicine , Winston-Salem, NC, USA
| | - John J McNeil
- 1 161667 School of Public Health and Preventive Medicine, Monash University , Melbourne, Australia
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14
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Abstract
INTRODUCTION Sepsis is a leading global cause of morbidity and mortality, and is more common at the extremes of age. Moreover, the cost of in-hospital care for elderly patients with sepsis is significant. There are indications from experimental and observational studies that aspirin may reduce inflammation associated with infection. This paper describes the rationale and design of the AspiriN To Inhibit SEPSIS (ANTISEPSIS) trial, a substudy of ASPirin in Reducing Events in the Elderly (ASPREE). ANTISEPSIS primarily aims to determine whether low-dose aspirin reduces sepsis-related deaths in older people. Additionally, it will assess whether low-dose aspirin reduces sepsis-related hospitalisations and sepsis-related Intensive Care Unit (ICU) admissions. METHODS AND ANALYSIS ASPREE is a double-blinded, randomised, placebo-controlled primary prevention trial that will determine whether daily low-dose aspirin extends disability-free longevity in 19 000 healthy older people recruited in Australia and the USA. The ANTISEPSIS substudy involves additional ASPREE trial data collection to assess the impact of daily low-dose aspirin on sepsis-related events in the 16 703 ASPREE participants aged 70 years and over, recruited in Australia. The intervention is a daily 100 mg dose of enteric-coated aspirin versus matching placebo, with 1:1 randomisation. The primary outcome for the ANTISEPSIS substudy is the incidence of sepsis-related death in eligible patients. The incidence of sepsis-related hospital and ICU admissions are secondary outcomes. ANTISEPSIS is to be conducted between 2012 and 2018. DISCUSSION This substudy will determine whether aspirin, an inexpensive and accessible therapy, safely reduces sepsis-related deaths and hospitalisations in older Australians. If shown to be the case, this would have profound effects on the health of older Australians. TRIAL REGISTRATION NUMBER Pre-results, ACTRN12613000349741.
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Affiliation(s)
- Damon P Eisen
- Townsville Hospital and Health Service, Townsville, Queensland, Australia
- Division of Tropical Health and Medicine, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Elizabeth M Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service at the Peter Doherty Institute, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jessica Lockery
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Emma S McBryde
- Division of Tropical Health and Medicine, Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Queensland, Australia
| | - John J McNeil
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Pilcher
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Intensive Care, The Alfred Hospital, Melbourne, Victoria, Australia
- The Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcome and Resource Evaluation (CORE), Melbourne, Victoria, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L Woods
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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