The big picture on aspirin

Above: (L to R) Veteran Australian actors and trial participants, Terry Norris [Bellbird, Matlock Police, Cop Shop, Romulus, My Father] and John Flaus [Newsfront, The Castle, The Dish, Crackerjack], discuss the ASPREE trial with Professor John McNeil

The ASPREE study is currently recruiting for healthy Australians aged 70 and over in: Melbourne, regional Victoria, Tasmania, ACT/regional NSW and Adelaide.

Participants are currently not being recruited from WA, NT and QLD.

By Keryn Curtis

Researchers are looking to recruit another 6000 Australians, aged 70 and over, to complete the Australian arm of the world’s largest primary prevention aspirin study ever undertaken in older people.

The ASPREE study (ASPirin in Reducing Events in the Elderly) is a long term study being conducted jointly by researchers in Australia and the United States, which aims to fully understand the risks and benefits of taking aspirin preventively, specifically for older people, who are at higher risk of heart attacks and strokes.

Researchers this week celebrated the milestone of 10,000 enrolled Australian participants since it commenced in 2011, but that is still 6,000 shy of the study’s goal of 19,000 enrolments by December 2013.

Principal Investigator for the study, Professor John McNeil, Head of Monash University’s Department of Epidemiology and Preventive Medicine, said the study had been supported strongly by general practitioners working in the community who had been recruiting between 400 and 500 participants every month.

“With a big, high profile study like this, all the GPs know and you can get a critical mass. So volunteers are flying in.

“We’ve had an outstanding response in regional areas with lots of enrolments from people living in the country.”

Prof McNeil said the study had been very lucky to receive Victorian Government funding to establish study centres in regional towns.

“Having these regional centres with local staff has made it possible for country people to be involved and they have been outstanding in the way they have participated. It has been terrific for the regional GPs too.”

The true picture on asprin

The study is investigating whether a daily low dose of aspirin can potentially delay or prevent the onset of common age-related diseases such as heart attack, certain types of stroke, dementia and certain cancers, in healthy people aged 70 and over.

After an initial screening process, eligible participants are randomly assigned to take a daily tablet; half of the participants will be taking 100mg of aspirin and half will be taking a placebo. Participants also undergo free annual health checks for an average of five years.

Professor McNeil says the study is long overdue and will play a crucial role in determining once and for all if the benefits of aspirin outweigh the risks.

“Most studies of drugs focus on younger age groups or look only at the benefits of the drug, not the negatives. It is no longer enough to do a clinical trial just looking at the positive results of a drug. We need to look at the negative side and look at the effects on balance. People over the age of 70 have not been the subject of research of this kind.”

Above: ASPREE principal investigator, Professor John McNeil

Confusing messages about aspirin

Professor McNeil said because aspirin is the most widely used drug in the world, there was a lot of media reporting of research related to a wide range of different effects associated with it.

“In the last three or four years, there has been so much more,” he said. “Some of the stories about its effects are bad and some are good. It’s about fifty-fifty.”

“The recent publicity around a study showing a link with increased likelihood of macular degeneration made things worse. What the publicity didn’t say was that there are equal numbers of good studies that say that aspirin improves it. Some studies say it improves macular degeneration and some say it makes it worse.

“I had a job explaining it all to participants because you wouldn’t know this context - that this was just one of a number of studies; that there is an equal number that say it helps macular degeneration.

“And most of that research is drawn from observational data, a very second rate research method compared with ASPREE. We are looking at macular degeneration in ASPREE and will have much better information,” Professor McNeil said.

A big picture on older people’s health

Because of the size and long term nature of the study, Professor McNeil said there was a lot of communication between researchers and participants in the study, including regular phone calls and ‘the odd questionnaire’.

“It keeps us in contact but it also enables people to provide information that was never available for this older age group. There has been no systematic collection process for [health information about] older Australians.

“When I went to Ballarat and spoke to the GPs there, there was more concern about dental health. This study will provide more and better information about dental health in this age group than we have ever known in the past.”

Professor McNeil said it was an indication of how important this information is to doctors that 1800 GPs had already signed up as co-investigators and were recommending the study to their patients.

“It is an unprecedented number,” he said.

“One of the reasons [ASPREE] is interesting to all doctors is that it aims to find out whether aspirin prolongs disability free survival. This has become a really important agenda for health all over the world. How can we find ways to keep people independent and well and living at home for as long as possible?

“This is the first international study focusing simply on that question. To be honest, it should have been done 20 years ago. It was obvious in 1990 that aspirin in older people was an important question. But it took a long time.

“Basically if you’ve got to 70 or 75 and you haven’t had heart attack or stroke, we’d like to see you,” said Professor McNeil.

How to join the study

The ASPREE study is now calling for healthy participants, not already taking dailiy aspirin, in Victoria, Tasmania, the ACT, regional NSW and Adelaide. Participants are currently not being recruited from WA, NT and QLD.

Most participants enrol in the study through their general practitioner but there is an ASPREE study website for information.

ASPREE: http://www.aspree.org/AUS/aspree-content/aspree-study-details/about-aspree.aspx

Read previous articles about the ASPREE study on the Australian Ageing Agenda Website: