[AF] ¿Acabaremos tomando todos aspirina?

Ramon Diaz-Alersi ramon.diazalersi en gmail.com
Mar Dic 7 15:40:45 CET 2010

Todavía no está en Pubmed:
The Lancet, Early Online Publication, 7 December 2010
Effect of daily aspirin on long-term risk of death due to cancer: analysis
of individual patient data from randomised trials

Original Text
Prof Peter M Rothwell<http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Peter%20M+Rothwell>FMedSci
Corresponding Author]<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2962110-1/fulltext#cor1>[image:
Email Address] <peter.rothwell en clneuro.ox.ac.uk>, Prof F Gerald R
Prof Jill FF Belch<http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Jill%20FF+Belch>FRCP
Hisao Ogawa<http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Hisao+Ogawa>MD
Prof Charles P Warlow<http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Charles%20P+Warlow>FMedSci
Prof Tom W Meade<http://www.thelancet.com/search/results?fieldName=Authors&searchTerm=Tom%20W+Meade>FRS

Treatment with daily aspirin for 5 years or longer reduces subsequent risk
of colorectal cancer. Several lines of evidence suggest that aspirin might
also reduce risk of other cancers, particularly of the gastrointestinal
tract, but proof in man is lacking. We studied deaths due to cancer during
and after randomised trials of daily aspirin versus control done originally
for prevention of vascular events.
We used individual patient data from all randomised trials of daily aspirin
versus no aspirin with mean duration of scheduled trial treatment of 4 years
or longer to determine the effect of allocation to aspirin on risk of cancer
death in relation to scheduled duration of trial treatment for
gastrointestinal and non-gastrointestinal cancers. In three large UK trials,
long-term post-trial follow-up of individual patients was obtained from
death certificates and cancer registries.
In eight eligible trials (25 570 patients, 674 cancer deaths), allocation to
aspirin reduced death due to cancer (pooled odds ratio [OR] 0·79, 95% CI
0·68—0·92, p=0·003). On analysis of individual patient data, which were
available from seven trials (23 535 patients, 657 cancer deaths), benefit
was apparent only after 5 years' follow-up (all cancers, hazard ratio [HR]
0·66, 0·50—0·87; gastrointestinal cancers, 0·46, 0·27—0·77; both p=0·003).
The 20-year risk of cancer death (1634 deaths in 12 659 patients in three
trials) remained lower in the aspirin groups than in the control groups (all
solid cancers, HR 0·80, 0·72—0·88, p<0·0001; gastrointestinal cancers, 0·65,
0·54—0·78, p<0·0001), and benefit increased (interaction p=0·01) with
scheduled duration of trial treatment (=7·5 years: all solid cancers, 0·69,
0·54—0·88, p=0·003; gastrointestinal cancers, 0·41, 0·26—0·66, p=0·0001).
The latent period before an effect on deaths was about 5 years for
oesophageal, pancreatic, brain, and lung cancer, but was more delayed for
stomach, colorectal, and prostate cancer. For lung and oesophageal cancer,
benefit was confined to adenocarcinomas, and the overall effect on 20-year
risk of cancer death was greatest for adenocarcinomas (HR 0·66, 0·56—0·77,
p<0·0001). Benefit was unrelated to aspirin dose (75 mg upwards), sex, or
smoking, but increased with age—the absolute reduction in 20-year risk of
cancer death reaching 7·08% (2·42—11·74) at age 65 years and older.
Daily aspirin reduced deaths due to several common cancers during and after
the trials. Benefit increased with duration of treatment and was consistent
across the different study populations. These findings have implications for
guidelines on use of aspirin and for understanding of carcinogenesis and its
susceptibility to drug intervention.

Ramón Díaz-Alersi

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