The ASPirin in Reducing Events in the Elderly (ASPREE) Study won ACTA’s 2019 ‘Trial of the Year’ Award after finding that low-dose aspirin did not increase the time which over elderly people remained free of disability or dementia.

The ASPREE trial was initially funded because the effects of aspirin on older people were inconclusive—and doubts were starting to arise about whether earlier studies, mainly conducted in younger people, applied to an older generation. The ASPREE study was unique in its strong partnership with general practitioners (GPs), who are responsible for delivering most of the preventative healthcare in Australia.

“They see in their practice every day, people who are over 70 and a question in their mind is, ‘what can I do to help this person stay healthy for as long as possible?’. Aspirin was always a part of that equation in the past—but no longer except for those who have previously had evidence of atherosclerosis (thickening) in the blood vessels supplying the heart or brain. Aspirin is falling out of favour for healthy people and unless its preventative effect on cancer is more clearly demonstrated, I think it’s likely to stay out of favour.” Said Professor John McNeil—Australian Principal investigator on the ASPREE study.

Since the trial concluded, the ASPREE team from Monash’s Department of Public Health and Preventative Medicine has kept its foot on the accelerator. The National Institute of Health in the US, has awarded further funding to the trial team to investigate long-lasting effects of daily aspirin use on cancer—particularly bowel cancer. For this reason, the ASPREE team are continuing to reach out to those in Australia and America who were in the original ASPREE trial to continue to monitor their health.

“We originally set out to find out if people who take aspirin frequently extend their healthy lifespan. And it didn’t. But that doesn’t mean beneficial effects such as delaying cancer wouldn't appear after the trial. ASPREE participants are helping us to answer this question.” said Professor McNeil. The ASPREE study was recognised for its large-scale community-based recruitment and the collaboration with over 2000 Australian general practitioners. It represents a large US/Australian investment to clarify the value of a drug used by millions of elderly people internationally.

The additional funding is set to last until 2024.

ASPREE and involving consumers

Study participants were exclusively healthy individuals over the age of 70, who were required to take 100mg of aspirin or a matching placebo daily. Consumers were involved at every stage of the trial and participants were regularly informed of developments in the study.

The novelty of ASPREE

One of the interesting things about ASPREE is that even though it focuses on aspirin, a lot of the same questions are being asked about other widely used drugs for prevention in the elderly including the statins. Following the success with ASPREE, the NHMRC has funded the STAtins in Reducing Events in the Elderly (StaREE) trial which is following a very similar approach to the recruitment and follow-up of community-based participants across Australia.

Next steps—the StaREE trial

The StaREE trial is currently in a recruitment phase and aims to assess the impact of another widely used drug, a statin, for prevention in older people. Statins were initially developed to lower blood cholesterol levels and consequently reduce the risk of heart disease. StaREE will aim to assess the ability of statins to prolong disability-free survival in older people.

“The StaREE trial is important because it may also clarify the importance of a preventive drug used by millions of elderly people and there’s a lot of international interest. While ASPREE is continuing, StaREE is continuing to recruit participants under the leadership of Professor Sophia Zoungas from the Monash School of Public Health & Preventive Medicine

Like ASPREE, information collected for STAREE will be used to devise strategies to keep older Australians living healthy, independent and productive lives within the community. STAREE is also the first statin-placebo control, double-blind, randomised trial of a statin exclusively enrolling older individuals.