Current Aspirin Use Research Articles

How effective are dose-adjusted warfarin and aspirin for the prevention of stroke in patients with chronic atrial fibrillation?

The objective of this study was to evaluate the rate of stroke associated with aspirin and warfarin in routine clinical practice. The study included patients aged 40+ with chronic atrial fibrillation (cAF) registered in the UK General Practice Research Database. The outcome was the rate of stroke during current, past and no use of aspirin and warfarin. The study included 51,807 cAF patients. There was no difference in the rate of stroke between current and past use of aspirin (relative rate [RR] = 1.04 [95% confidence interval (CI) 0.94 - 1.15]), while the rate of stroke was reduced during current warfarin use compared to past use (RR = 0.62 [95% CI 0.54 - 0.71]). For warfarin, a pattern of lower rates of stroke during current exposure and higher rates with past exposure was seen only in patients treated for at least 6-12 months. For aspirin, no changes in the rates of stroke were observed with discontinuation of aspirin. The effectiveness of warfarin was dependent on the level of anticoagulation, with optimal risk reduction occurring within the recommended international normalised ratio (INR) range of 2.0 to 3.0. The proportion of patients achieving a stable INR within the target therapeutic range was at its lowest during the first three months of warfarin treatment. In conclusion, the results of this study support the effectiveness of warfarin treatment to reduce the rate of stroke in cAF patients in the general clinical practice setting, however the risk reduction is lower than that reported in clinical trials.

Aspirin, NSAID, and Acetaminophen Use and the Risk of Endometrial Cancer

To date, no prospective studies have explored the relationship between the use of aspirin, other nonsteroidal anti-inflammatory medications (NSAID), and acetaminophen and endometrial adenocarcinoma. Of the 82,971 women enrolled in a prospective cohort study, 747 developed medical record-confirmed invasive endometrial cancer over a 24-year period. Use of aspirin was ascertained from 1980 to 2004, and for other NSAIDs and acetaminophen, from 1990 to 2004. Cox regression models calculated multivariate relative risks (MV RR), controlling for body mass index (BMI), postmenopausal hormone (PMH) use, and other endometrial cancer risk factors. Currency, duration, and quantity of aspirin were not associated with endometrial cancer risk overall [current use: MV RR, 1.03; 95% confidence interval (CI) 0.83-1.27; >10 years of use: MV RR, 1.01; 95% CI, 0.78-1.30; and cumulative average >7 tablets per week: (MV RR, 1.10; 95% CI, 0.84-1.44)]. However, stratified analyses showed that a lower risk of endometrial cancer among obese (BMI, >or=30 kg/m(2)) women was seen with current aspirin use (MV RR, 0.66; 95% CI, 0.46-0.95). The greatest risk reduction for current aspirin users was seen in postmenopausal obese women who had never used PMH (MV RR, 0.43; 95% CI, 0.26-0.73). The use of other NSAIDs or acetaminophen was not associated with endometrial cancer. Our data suggest that use of aspirin or other NSAIDs does not play an important role in endometrial cancer risk overall. However, risk was significantly lower for current aspirin users who were obese or who were postmenopausal and had never used PMHs; these subgroup findings require further confirmation.

Aspirin Use Among Adults Aged 40 and Older in the United States: Results of a National Survey

Aspirin is effective for the primary and secondary prevention of cardiovascular events, but its use has been suboptimal. Investigators performed a nationally representative Internet-based survey of U.S. consumers aged 40 and older using online databases maintained by Harris Interactive((R)) to measure use of aspirin for cardiovascular disease (CVD) prevention and factors associated with its use. Respondents reported whether they used aspirin therapy regularly for cardiovascular prevention; and provided information about their cardiovascular risk factors, discussions with their healthcare provider about aspirin therapy, and their perceptions about risks and benefits of aspirin. Objective risk of cardiovascular events was estimated using counts of self-reported risk factors. Survey results were weighted to be representative of the general U.S. population. Researchers performed bivariate and multivariate analyses to understand factors associated with aspirin use. A total of 1299 adults aged 40 or older completed the survey. Mean age was 55.9, 53% were women, 79% self-identified as white, 10% African American, and 9% Latino. Current regular aspirin use for CVD prevention was reported by 41% of respondents. The factor most strongly associated with aspirin use was reporting a previous conversation with a healthcare provider about aspirin (88% aspirin use among respondents reporting such discussion versus 17% who did not report discussion; odds ratio 36.6, 95% confidence interval 25.9-51.7). Aspirin use is low, even among patients at increased risk. Better provider-patient communication about aspirin prevention is associated with greater use, and should be a target for future interventions.

Environmental risk factors in the development of adenocarcinoma of the oesophagus or gastric cardia: a cross‐sectional study in a Dutch cohort

Risk factors for adenocarcinoma of the oesophagus (OAC) and gastric cardia (GCA) are not yet established. To compare environmental risk factors between patients with OAC and GCA. One-hundred and twenty-six patients with OAC, 43 with GCA and 57 with squamous cell carcinoma filled out a questionnaire with information on demographic and lifestyle characteristics, physical activity levels, family history, gastro-oesophageal reflux disease symptoms and medication use. OAC and GCA patients were similar with regard to male predominance and age, alcohol intake and smoking, use of fruits and vegetables, body posture and occupational activities (P > 0.05). GCA patients less often had heartburn compared with OAC patients [odds ratio (OR) 0.5, 95% confidence interval (CI) 0.2-0.96] and had these symptoms less frequently and for a shorter period (OR 0.3, CI 0.1-1.0 and OR 0.1, CI 0.03-0.6, respectively). Former and current aspirin use was lower among GCA patients than OAC patients (OR 0.2, CI 0.05-0.7 and OR 0.4, CI 0.1-0.9, respectively), whereas no difference in non-steroidal anti-inflammatory drug use was detected. Although OAC and GCA share several environmental risk factors, OAC is more frequently associated with a history of gastro-oesophageal reflux disease, suggesting a more important role for gastro-oesophageal reflux in OAC compared with GCA.

Long-term Aspirin Use and Mortality in Women

The influence of long-term use of aspirin on total mortality in women remains uncertain. We conducted a prospective, nested, case-control study of 79 439 women enrolled in the Nurses' Health Study who had no history of cardiovascular disease or cancer. Women provided data on medication use biennially since 1980. We assessed relative risk (RR) of death according to aspirin use before diagnosis of incident cardiovascular disease or cancer and during the corresponding period for each control subject. During 24 years, we documented 9477 deaths from all causes. In women who reported current aspirin use, the multivariate RR of death from all causes was 0.75 (95% confidence interval, 0.71-0.81) compared with women who never used aspirin regularly. The risk reduction was more apparent for death from cardiovascular disease (RR, 0.62; 95% confidence interval, 0.55-0.71) than for death from cancer (RR, 0.88; 95% confidence interval, 0.81-0.96). Use of aspirin for 1 to 5 years was associated with significant reductions in cardiovascular mortality (RR, 0.75; 95% confidence interval, 0.61-0.92). In contrast, a significant reduction in risk of cancer deaths was not observed until after 10 years of aspirin use (P(linear trend) = .005). The benefit associated with aspirin was confined to low and moderate doses and was significantly greater in older participants (P(interaction)< .001) and those with more cardiac risk factors (P(interaction) = .02). In women, low to moderate doses of aspirin are associated with significantly lower risk of all-cause mortality, particularly in older women and those with cardiac risk factors. A significant benefit is evident within 5 years for cardiovascular disease, whereas a modest benefit for cancer is not apparent until after 10 years of use.

Association between Nonsteroidal Anti-inflammatory Drug Use and the Incidence of Lung Cancer in the Iowa Women's Health Study

Previous studies have suggested that use of aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reduced risk of lung cancer, but the data are inconsistent and are limited particularly with respect to the effects of aspirin, separate from other NSAIDs. The Iowa Women's Health Study is a prospective cohort of 41,836 Iowa women ages 55 to 69 years old at baseline in 1986. NSAID use was assessed in 1992. Over 10 years of follow-up, 403 incident cases of lung cancer were identified. The association of incident lung cancer with current use of aspirin or non-aspirin NSAIDs was analyzed after adjustment for lung cancer risk factors. Hazard ratios (HR) were estimated using multivariate COX proportional hazards regression. There were 27,162 women in the analytic cohort. After controlling for age, education, alcohol intake, pack-years, smoking status, body mass index, and total fruit intake, the RR of women taking six or more aspirin weekly was 1.21 (95% confidence interval, 0.92-1.59). The HR was 1.23 for women taking six or more non-aspirin NSAIDs weekly (95% confidence interval, 0.92-1.65). There was no statistically significant trend by frequency of use for either aspirin (P(trend) = 0.22) or non-aspirin NSAIDs (P(trend) = 0.53). Analyses by histologic type and smoking status yielded similar null results. Information on dosage and duration of use were not available for this analysis. These findings do not suggest that aspirin or other NSAIDs reduce risk of lung cancer in this cohort of postmenopausal women.

Effects of Conjugated Equine Estrogen on Stroke in the Women’s Health Initiative

The Women's Health Initiative (WHI) Estrogen Alone trial assessed the balance of benefits and risks of hormone use in healthy postmenopausal women. The trial was stopped prematurely because there was no benefit for coronary heart disease and an increased risk of stroke. This report provides a thorough analysis of the stroke finding using the final results from the completed trial database. The WHI Estrogen Alone hormone trial is a multicenter, double-blind, placebo-controlled, randomized clinical trial in 10,739 women aged 50 to 79 years who were given daily conjugated equine estrogen (CEE; 0.625 mg; n=5310) or placebo (n=5429). During an average follow-up of 7.1 years, there were 168 strokes in the CEE group and 127 in the placebo group; 80.3% of strokes were ischemic. For all stroke the intention-to-treat hazard ratio [HR] (95% CI) for CEE versus placebo was 1.37 (1.09 to 1.73). The HR (95% CI) was 1.55 (1.19 to 2.01) for ischemic stroke and 0.64 (0.35, 1.18) for hemorrhagic stroke. The HRs indicate excess risk of ischemic stroke was apparent in all categories of baseline stroke risk, including younger and more recently menopausal women and in women with prior or current use of statins or aspirin. CEE increases the risk of ischemic stroke in generally healthy postmenopausal women. The excess risk appeared to be present in all subgroups of women examined, including younger and more recently menopausal women. There was no convincing evidence to suggest that CEE had an effect on the risk of hemorrhagic stroke.

A Large Cohort Study of Aspirin and Other Nonsteroidal Anti-Inflammatory Drugs and Prostate Cancer Incidence

Background: Use of aspirin and other nonsteroidal antiinfl ammatory drugs (NSAIDs) has consistently been associated with a reduced risk of colon cancer. Recent epidemiologic studies have suggested that the use of NSAIDs, particularly aspirin, may also be associated with a reduced risk of prostate cancer, but the evidence remains limited. Methods: We examined the association between NSAID use and prostate cancer incidence among 70 144 men in the American Cancer Society’s Cancer Prevention Study II Nutrition Cohort. Information on NSAID use was obtained from a questionnaire completed at study enrollment in 1992 – 1993 and was updated using follow-up questionnaires in 1997 and 1999. We calculated rate ratios (RRs) and 95% confi dence intervals (CIs) for prostate cancer incidence associated with NSAID use, adjusting for age and potential prostate cancer risk factors. Results: During follow-up from 1992 – 1993 through August 31, 2001, 4853 cases of incident prostate cancer were identifi ed. Neither current aspirin use nor current use of NSAIDs (aspirin and other NSAIDs combined) was associated with prostate cancer risk, even at the highest usage level (60 or more pills per month). However, long-duration regular use (30 or more pills per month for 5 or more years) of NSAIDs was associated with reduced risk of prostate cancer (RR = 0.82, 95% CI = 0.71 to 0.94). Longduration regular use of aspirin was also associated with reduced risk of prostate cancer (RR = 0.85, 95% CI = 0.73 to 0.99). The absolute rate of prostate cancer (standardized to the age distribution of study participants using 5-year age categories) was 1013 per 100 000 person-years among men who had never reported NSAID use, and 847 per 100 000 person-years among long duration regular NSAID users. Conclusions: These results support the hypothesis that long duration regular NSAID use is associated with modestly reduced risk of prostate cancer. [J Natl Cancer Inst 2005;97:975 – 80]

A Large Cohort Study of Aspirin and Other Nonsteroidal Anti-inflammatory Drugs and Prostate Cancer Incidence

Use of aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) has consistently been associated with a reduced risk of colon cancer. Recent epidemiologic studies have suggested that the use of NSAIDs, particularly aspirin, may also be associated with a reduced risk of prostate cancer, but the evidence remains limited. We examined the association between NSAID use and prostate cancer incidence among 70 144 men in the American Cancer Society's Cancer Prevention Study II Nutrition Cohort. Information on NSAID use was obtained from a questionnaire completed at study enrollment in 1992-1993 and was updated using follow-up questionnaires in 1997 and 1999. We calculated rate ratios (RRs) and 95% confidence intervals (CIs) for prostate cancer incidence associated with NSAID use, adjusting for age and potential prostate cancer risk factors. During follow-up from 1992-1993 through August 31, 2001, 4853 cases of incident prostate cancer were identified. Neither current aspirin use nor current use of NSAIDs (aspirin and other NSAIDs combined) was associated with prostate cancer risk, even at the highest usage level (60 or more pills per month). However, long-duration regular use (30 or more pills per month for 5 or more years) of NSAIDs was associated with reduced risk of prostate cancer (RR = 0.82, 95% CI = 0.71 to 0.94). Long-duration regular use of aspirin was also associated with reduced risk of prostate cancer (RR = 0.85, 95% CI = 0.73 to 0.99). The absolute rate of prostate cancer (standardized to the age distribution of study participants using 5-year age categories) was 1013 per 100,000 person-years among men who had never reported NSAID use, and 847 per 100,000 person-years among long duration regular NSAID users. These results support the hypothesis that long duration regular NSAID use is associated with modestly reduced risk of prostate cancer.

Potential limitations of electronic database studies of prescription non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) and risk of myocardial infarction (MI)

To determine whether specific limitations in electronic database studies may lead to biased estimates of the association between prescription, non-selective non-aspirin non-steroidal anti-inflammatory drugs (NANSAIDs) and myocardial infarction (MI) METHODS: Using our case-control study of NANSAIDs and first, non-fatal MI, we determined the odds ratio (OR) for prescription NANSAIDs and MI. In the 'Replicating Electronic Database Analysis,' we considered non-prescription NANSAID users to be 'non-users,' did not stratify by aspirin use, and did not adjust for confounders typically unavailable or incomplete in existing databases. In the 'Misclassification Assessment Analysis,' we removed non-prescription NANSAIDs from the 'non-user' category. In the 'Confounding Assessment Analysis #1,' we additionally adjusted for smoking, family history, and years of education. In the 'Confounding Assessment Analysis #2,' we also adjusted for body mass index (BMI) and physical activity. In the 'Interaction Assessment Analysis,' we stratified on aspirin use and repeated the latter analysis. The prevalence of current NANSAID and aspirin use was higher in our controls than in electronic database studies, consistent with the fact that non-prescription NANSAIDs accounted for 81% of all NANSAID use. Education, physical activity, and BMI also were associated with prescription NANSAID use. When each potential source of bias was removed, the OR for NANSAIDs moved further from 1.0 (i.e., toward a protective association with MI): 'Replicating Electronic Database' analysis (OR 1.00, 95% confidence interval [CI]: 0.78--1.28); 'Misclassification Assessment Analysis' (OR 0.89, 95%CI: 0.70--1.14); 'Confounding Assessment Analysis #1' (OR 0.85, 95%CI: 0.66--1.10); 'Confounding Assessment Analysis #2' (OR 0.78, 95%CI: 0.60--1.01); 'Interaction Assessment Analysis' (OR 0.69, 95%CI: 0.51--0.95). Limitations in electronic databases may be responsible for the lack of association of NANSAIDs on lower MI risk noted in these studies. Further studies-preferably randomized trials-are needed to address the risk-benefit ratio of NANSAID use.

Current Use of Nonsteroidal Antiinflammatory Drugs and the Risk of Acute Myocardial Infarction

To evaluate the risk of acute myocardial infarction during current exposure to nonsteroidal antiinflammatory drugs (NSAIDs). Retrospective case-control analysis. General practice offices. A total of 8688 case patients, aged 89 years or younger, with a first-time acute myocardial infarction and 33,923 control subjects matched on age, sex, calendar time, and general practice attended. The United Kingdom General Practice Research Database was searched for potential cases of first-time acute myocardial infarction between January 1995 and April 2001. Control subjects without acute myocardial infarction were identified at random. Exposure to NSAIDs was assessed, and 650 case patients and 2339 control subjects were found to be currently taking NSAIDs. After adjusting for various risk factors for acute myocardial infarction (e.g., hypertension, hyperlipidemia, diabetes mellitus, ischemic heart disease, body mass index, smoking), the relative risk (expressed as odds ratio [OR]) of acute myocardial infarction was 1.07 (95% confidence interval [CI] 0.96-1.19) for subjects with current NSAID exposure compared with those not taking NSAIDs. The adjusted OR for current diclofenac use was 1.23 (95% CI 1.00-1.51), for current ibuprofen use 1.16 (95% CI 0.92-1.46), and for current naproxen use 0.96 (95% CI 0.66-1.38) compared with those not taking NSAIDs. Current aspirin use combined with current NSAID use was associated with a statistically significant risk reduction (adjusted OR 0.74, 95% CI 0.57-0.97), compared with nonuse of NSAIDs and aspirin. Current use of aspirin together with current use of ibuprofen yielded an adjusted OR of 0.69 (95% CI 0.42-1.15). Our results provide additional evidence that the risk of first-time acute myocardial infarction during current use of NSAIDs is not materially altered. We found no evidence for a reduced cardioprotective effect of aspirin with concomitant NSAID use.

Risk Assessment of Infectious Complications in Patients Undergoing Endoscopic Ultrsound (EUS) Guided Celiac Plexus Block (CPB): A Multicenter Experience

EUS-guided CPB has been reported to be a promising alternative method for managing abdominal pain due to GI malignancy or chronic pancreatitis. Sparse data exists on the safety of this technique. There is some data on infectious complications associated with EUS fine needle aspiration. The aim of this study was to evaluate the risk of developing an infectious complication associated with EUS CPB and the role antibiotics and proton pump inhibitors (PPI) may play in both the reduction and development of such complications, respectively. Methods: This multicenter study is comprised of two cohorts: Prospective data collected from institution #1 between January 1, 2000 and December 1, 2002 on 28 consecutive patients (pts) and retrospective data collected between December 1, 1999 and November 1, 2004 on 13 pts identified through a search of our endoscopic database at institution #2; all undergoing EUS-guided CPB for chronic abdominal pain. The following parameters were recorded: CPB indication, age, co-morbidities, antibiotic (pre- or post-procedure) use and current use of PPI, aspirin or other anticoagulation. Pts were followed for signs or symptoms suggesting a complication including pain, fever, bleeding and leukocytosis. Results: A total of 41 EUS CPB's were performed. 46.3% of pts were on a PPI. In 21.9% of cases, the prophylactic use of antibiotics occurred for other reasons (i.e. co-morbidities, prosthetic heart valves). 58.5% of procedures were not associated with pre- or post-procedure antibiotic use. There were no complications noted in 95.1% of cases. However, 4.9% of cases were followed by mild self-limited epigastric discomfort. There were no reports of fever, leukocytosis, bleeding or abscess formation. No significant differences existed in the complication risk between the PPI versus no PPI groups (p > 0.05) or the antibiotic versus no antibiotic groups (p > 0.05). There was no significant difference between the 2 cohort groups in terms of complications and the use of antibiotics or PPI's (p > 0.05). Conclusions: No infectious complications were observed following EUS CPB. No correlation of infectious complications was observed with the use of a PPI or antibiotics. The results of this multicenter study raise the question as to the need for prophylactic antibiotics prior to EUS CPB. Further studies using a prospective randomized comparison of antibiotics and PPI's or assessing the presence of bacteremia after EUS-guided CPB are warranted.

Nonsteroidal Anti-inflammatory Drugs and Risk of Prostate Cancer in the Baltimore Longitudinal Study of Aging

Laboratory and epidemiologic studies suggest that aspirin and nonaspirin nonsteroidal anti-inflammatory drugs (NSAID) reduce the risk of cancer, possibly via inhibition of the cyclooxygenase enzymes. We evaluated the association of aspirin and nonaspirin NSAIDs with subsequent prostate cancer in a prospective study. We also assessed whether use of these drugs influences serum prostate-specific antigen (PSA) concentration. Participants were 1,244 male members of the Baltimore Longitudinal Study of Aging. Use of prescription and over-the-counter drugs was collected by questionnaire and interview at multiple study visits. One hundred forty-one prostate cancer cases diagnosed between 1980 and May 2004 were confirmed by medical record review. We used Cox proportional hazards regression to estimate the rate ratio (RR) of prostate cancer updating drug use over time and taking into account age and year. We used generalized estimating equations to calculate age-adjusted geometric mean PSA concentration by aspirin or nonaspirin NSAIDs use among 933 of the men without prostate cancer, for whom 3,749 PSA measurements in archived sera had been done previously. On 46.0% and 21.5% of the visits, current use of aspirin or nonaspirin NSAIDs (mostly ibuprofen) was reported, respectively. The RRs of prostate cancer comparing ever to never use were 0.76 [95% confidence interval (95% CI), 0.54-1.07] for aspirin, 0.79 (95% CI, 0.54-1.16) for nonaspirin NSAIDs, and 0.71 (95% CI, 0.49-1.02) for either medication. The association for ever use of either aspirin or nonaspirin NSAIDs was suggestively more pronounced in men <70 years (RR, 0.54; 95% CI, 0.27-1.03) than in men >/=70 years (RR, 0.78; 95% CI, 0.50-1.22; P(interaction) = 0.73). The RR for current use of either drug was attenuated relative to ever use. Mean PSA concentration did not differ between users and nonusers of either aspirin or nonaspirin NSAIDs (1.01 versus 0.98 ng/mL, P = 0.56). In this prospective study, men, in particular younger men, who had ever used aspirin or nonaspirin NSAIDs had a modest nonstatistically significant lower risk of prostate cancer. The modest inverse association was unlikely due to detection bias that might have resulted if anti-inflammatory drugs had influenced serum PSA concentration.

Aspirin and Other Nonsteroidal Anti-inflammatory Drugs and Breast Cancer Incidence in a Large U.S. Cohort

Abstract Use of nonsteroidal anti-inflammatory drugs (NSAIDs), particularly aspirin, has consistently been associated with reduced risk of breast cancer in case-control studies. However, results from prospective studies have been less consistent. We examined the association between NSAID use and breast cancer incidence, adjusting for multiple breast cancer risk factors among 77,413 women in the Cancer Prevention Study II Nutrition Cohort. During follow-up from 1992 to 2001, we observed 3,008 cases of incident breast cancer. Information on NSAID use was obtained from a questionnaire completed at enrollment in 1992 or 1993 and was updated using follow-up questionnaires in 1997 and 1999. NSAID use was modeled using time-dependent variables to update exposure status. Neither current total NSAID use (aspirin and other NSAIDs combined) nor current aspirin use were associated with breast cancer incidence even at relatively high levels of use [rate ratio (RR), 1.07; 95% confidence interval (95% CI), 0.96-1.21 for ≥60 NSAID pills per month compared with no reported use of NSAIDs; RR, 1.01; 95% CI, 0.84-1.20 for ≥60 aspirin per month compared with no reported use of aspirin]. Even long-duration regular use (≥30 pills per month for ≥5 years) was not associated with breast cancer incidence (RR, 1.05; 95% CI, 0.88-1.26 for total NSAIDs; RR, 0.88; 95% CI, 0.69-1.12 for aspirin). Although we cannot exclude a small reduction in breast cancer risk associated with NSAID use, the results of this study provide evidence against a large reduction in risk.

Does an aspirin a day keep pancreas cancer away?

Does an aspirin a day keep pancreas cancer away?

Statins but not fibrates are associated with a reduced risk of venous thromboembolism: a hospital-based case-control study.

Previous studies of selected patients have suggested a reduction in the risk of venous thromboembolism with the use of statins. The objective of this study is to evaluate the influence of statin use on the risk of venous thromboembolic (VTE) events. The study is a case-control study (EDITH: Etude des Déterminants et Interactions de la Thrombose Veineuse), designed to investigate the genetic and environmental risk factors of VTE. A total of 377 patients consecutively hospitalized in the Brest University Hospital for a documented VTE event, between May 2000 and May 2002, and 377 age- and sex-matched controls were studied. Statin use was associated with a 58% decreased risk of VTE [odds ratio (OR) 0.42; 95% confidence interval (CI) 0.23-0.76; P = 0.002]. Adjustment for age, gender, coronary heart disease, atherosclerothrombotic disease or current use of aspirin did not alter the result. Neither fibrates (OR 1.38; 95% CI 0.76-2.52; P = 0.26), nor thienopyridines (OR 1.07; 95% CI 0.48-2.41; P = 0.85) were associated with a reduced risk of VTE. Aspirin use tended to decrease the risk of VTE, but this result was not significant (OR, 0.66; 95% CI, 0.42-1.05). The use of statins is associated with a significant reduction in the risk of VTE, irrespective of age, gender, and past history of atherosclerothrombotic disease, as well as the use of aspirin. This possible protective effect of statins warrants further investigations.

A prospective study of aspirin use and the risk of pancreatic cancer in women.

In vitro experiments and limited animal studies suggest that aspirin and nonsteroidal anti-inflammatory drugs may inhibit pancreatic carcinogenesis. Because few studies have examined the association between aspirin use and pancreatic cancer in humans and the results have been inconsistent, we examined the relationship between aspirin use and the development of pancreatic cancer in the Nurses' Health Study. Among 88 378 women without cancer at baseline, we documented 161 cases of pancreatic cancer during 18 years of follow-up. Aspirin use was first assessed at baseline in 1980 and updated biennially thereafter. All statistical tests were two-sided. Participants were classified according to history of aspirin use. In a multivariable analysis, the risk of pancreatic cancer was not associated with current regular aspirin use (defined as two or more standard tablets per week; relative risk [RR] = 1.20, 95% confidence interval [CI] = 0.87 to 1.65), compared with use of fewer than two tablets per week. Increasing duration of regular aspirin use, compared with non-use, was associated with a statistically significant increase in risk: Women who reported more than 20 years of regular aspirin use had an increased risk of pancreatic cancer (RR = 1.58, 95% CI = 1.03 to 2.43; P(trend) =.01). Among women who reported aspirin use on at least two of three consecutive biennial questionnaires compared with consistent non-users of aspirin, the risk increased with dose (one to three tablets per week: RR = 1.11, 95% CI = 0.70 to 1.76; four to six tablets per week: RR = 1.29, 95% CI = 0.70 to 2.40; seven to 13 tablets per week: RR = 1.41, 95% CI = 0.76 to 2.61; and > or = 14 tablets per week: RR = 1.86, 95% CI = 1.03 to 3.35) (P(trend) =.02). Extended periods of regular aspirin use appear to be associated with a statistically significantly increased risk of pancreatic cancer among women.

Regular use of nonsteroidal anti-inflammatory drugs and cognitive function in aging women.

To examine the relationship of nonsteroidal anti-inflammatory drug (NSAID) use and cognitive decline in young-old women. The authors prospectively studied 16,128 Nurses' Health Study participants, aged 70 to 81 years at baseline, who provided information on NSAID use and potential confounders in biennial questionnaires from 1976 through 1998. From 1995 through 2001, we administered, by telephone, six tests of cognitive function, including the Telephone Interview of Cognitive Status (TICS). Second interviews were begun 2 years later and completed on 13,255 women to date. The authors used multiple logistic regression to estimate relative risks (RR) of low baseline scores (defined as the bottom 10%) and substantial decline (worst 10%). Compared to never users, the RR was 0.75 (95% CI 0.59, 0.96) for a low baseline TICS score with current aspirin use of 15+ years duration, and 0.79 (95% CI 0.62, 1.02) for current use of NSAID (primarily ibuprofen) lasting 8+ years. Results for aspirin users were weaker on other tests, but long-term ibuprofen users had a RR of 0.75 (95% CI 0.56, 1.00) for a low baseline global score (combination of all six tests). The RR for substantial global cognitive decline was 0.93 (95% CI 0.68, 1.26) with long-term aspirin use, and 0.77 (95% CI 0.57, 1.05) with long-term ibuprofen use. In these young-old women, current, long-term NSAID users, especially of nonaspirin agents, showed reduced odds of low cognitive function and possibly lower rates of substantial cognitive decline over 2 years. Continued follow-up will help determine if associations differ at older ages.

Association between nonsteroidal anti-inflammatory drug use and the incidence of pancreatic cancer.

Laboratory studies indicate that nonsteroidal anti-inflammatory drugs (NSAIDs) may inhibit pancreatic cancer, but epidemiologic data to support this finding are limited. We conducted a prospective study from 1992 through 1999 among 28 283 postmenopausal women who lived in Iowa to examine the association between the self-reported use of aspirin and other NSAIDs and the incidence of pancreatic cancer. Eighty incident cases of pancreatic cancer were identified during 7 years of follow-up. The multivariate-adjusted relative risk of pancreatic cancer associated with any current use of aspirin versus no use was 0.57 (95% confidence interval = 0.36 to 0.90). There was a trend of decreasing risk of pancreatic cancer incidence with increasing frequency of aspirin use per week (P(trend) =.005). Nonaspirin NSAID use was not associated with incident pancreatic cancer. These data indicate that aspirin might be chemopreventive for pancreatic cancer.

Risk of mortality in a cohort of patients newly diagnosed with chronic atrial fibrillation.

To estimate the mortality rate of patients newly diagnosed with chronic atrial fibrillation (AF) and compare it with the one in the general population. To evaluate the role of co-morbidity and other factors on the risk of dying among AF patients. We used the General Practice Research Database in the UK to perform a retrospective cohort study. We followed a cohort of chronic AF patients (N = 1,035) and an age and sex matched cohort of 5,000 subjects sampled from the general population. We used all deceased AF patients as cases (n = 234) and the remaining AF patients as controls to perform a nested case-control analysis. We estimated mortality risk associated with AF using Cox regression. We computed mortality relative risks using logistic regression among AF patients. During a mean follow-up of two years, 393 patients died in the general population cohort and 234 in the AF cohort. Adjusted relative risk of death in the cohort of AF was 2.5 (95%CI 2.1 - 3.0) compared to the general population. Among AF patients, mortality risk increased remarkably with advancing age. Smokers carried a relative risk of dying close to threefold. Ischaemic heart disease was the strongest clinical predictor of mortality with a RR of 3.0 (95% CI; 2.1-4.1). Current use of calcium channel blockers, warfarin and aspirin was associated with a decreased risk of mortality. Chronic AF is an important determinant of increased mortality. Major risk factors for mortality in the AF cohort were age, smoking and cardiovascular co-morbidity, in particular ischaemic heart disease.