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Addressing preventive health measures in older patients


Morgan Liotta


16/04/2019 3:06:43 PM

newsGP talks to a researcher about the efficacy of aspirin as a preventive therapy for older people.

Professor Mark Nelson
Professor Mark Nelson’s research looked at the benefits of aspirin being used to prevent secondary health events, rather than as a preventive measure.

Professor Mark Nelson, GP and Research Fellow at the University of Tasmania, understands that older people make up a significant component of a GP’s workload, so integrating preventive health measures is par for the course.
 
‘I think a lot of what we already do with the aged [patients] is preventive,’ Professor Nelson told newsGP. ‘For example, lowering blood pressure in older women is critical in reducing their risk and incidence of stroke.’
 
Professor Nelson is a principal investigator on the ‘Aspirin in reducing events in the elderly’ (ASPREE) study, an international clinical trial conducted with participants in Australia and the US, which investigated the effectiveness of aspirin as a preventive therapy.
 
The double-blind placebo-controlled trial involved giving 100 mg of enteric-coated aspirin versus placebo for extension of healthy active life in those aged over 70 years. Its aim was to determine, for the first time, the balance of aspirin’s effects in healthy older people.
 
Results were published in The New England Journal of Medicine (NEJM), with the overall findings showing that no evidence that taking aspirin daily benefits as a preventive therapy for older people with good health.
 
‘Before doctors can know for sure if aspirin is helpful in prolonging healthy, disability-free life in older people, the benefits must be weighed against the risks,’ the study concluded.
 
Professor Nelson said general practice was essential to the successful completion of the study and its subsequent publication.
 
‘More than 2000 GPs participated [in the ASPREE study] as co-investigators and 16,703 Australian general practice patients,’ he said.
 
The ASPREE study was developed from an early 1990s study conducted on 400 older Australians that was designed to determine whether aspirin could reduce the incidence of stroke and myocardial infarction. According to Professor Nelson, the study then ‘languished’ – which is when he stepped in.
 
‘I was finishing my PhD in 2001 when [the PhD supervisor of the study] asked me if I could revive it,’ he said.
 
‘I applied for National Health and Medical Research Council [NHMRC] Australian Clinical Research Fellowship in that year with a new approach, including outcomes that are prevalent in the aged but not in middle-age, such as dementia, and was awarded it for 2002.
 
‘We then received funding for a feasibility study from the National Heart Foundation and published in 2005.’
 
This led to a $3.4 million NHMRC project grant and a grant of more than US$50 million from the National Institute on Aging, with the main ASPREE study commencing in 2010.
 
Professor Nelson hopes the study will help to address the theory that all older people should be taking aspirin, with his research showing that rather than being used as a preventive strategy, it should only be used for people who have a history of heart attack or stroke as a way of preventing secondary events.
 
Professor Nelson is also a principal investigator for the STAREE study, another large-scale clinical trial using the same methods to evaluate the benefits of taking statins as a preventive strategy for people aged 70 years and over.



aspirin medical research older people preventive health


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Dr Amir Samuel Philipos   18/04/2019 10:10:58 AM

I AGREE ASPIRIN SHOULD BE USED IF INDICATED FOR PEOPLE WITH PREVIOUS HEART DISEASE OR STROKE


Dr Chris Kear   25/04/2019 7:41:48 PM

It became obvious early on in the study that aspirin was no use at all. But the funding continued, so the study continued.
I'm glad it's through wasting research monies which can now be better applied elsewhere.


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