Frequency Of Aspirin Use Research Articles

Association Between Long-Term Aspirin Use and Frailty in Men: The Physicians' Health Study.

Chronic inflammation may lead to frailty, however the potential for anti-inflammatory medications such as aspirin to prevent frailty is unknown. We sought to examine the association between long-term aspirin use and prevalent frailty. We included 12 101 men ≥60 years who participated in the Physicians' Health Study I, a completed aspirin randomized controlled trial (1982-1989). Annual questionnaires collected self-reported data on daily aspirin use, lifestyle, and clinical variables. Average aspirin use was summed into 2 categories: ≤60 days/year and >60 days/year. Frailty was assessed using a 33-item index 11 years after trial completion. A score of ≥0.21 was considered frail. Propensity score inverse probability of treatment weighting was used for statistical control of confounding. Logistic regression models estimated odds of frailty as a function of categories of average aspirin use. Mean age was 70.5 years (range 60-101). Following an average of 11 ± 0.6 years of follow-up, aspirin use was reported as ≤60 days/year for 15%; 2413 participants (20%) were frail. Frequency of aspirin use was associated with smoking, alcohol consumption, hypertension, and cardiovascular disease, but negatively associated with bleeding and Coumadin use. The odds ratio (95% confidence intervals) for frailty was 0.85 (0.76-0.96) for average aspirin use >60 days/year versus aspirin use ≤60 days/year. Results were similar using an alternate definition of frailty. Long-term regular aspirin use is inversely associated with frailty among older men, even after consideration of multimorbidity and health behaviors. Work is needed to understand the role of medications with anti-inflammatory properties on aging.

Aspirin use and endometrial cancer risk: a meta-analysis and systematic review

BackgroundThe use of aspirin has been linked to a reduced risk of cancer at several sites, such as the breast, prostate, and colorectum. However, the evidence for this chemopreventive effect from aspirin use on endometrial cancer is conflicting, and whether an association exists is an open question.MethodsAfter carrying out a database search of articles published up to December 2019, we identified 7 case-control studies and 11 cohort studies, including a total of 14,766 endometrial cancer cases. We pooled the odds ratios (ORs) in case-control studies and risk ratios (RRs) in cohort studies, and then conducted subgroup analysis based on factors such as the frequency and duration of aspirin use, and obesity.ResultsIn the overall meta-analysis, we found a significant inverse association between any aspirin use and the risk of endometrial cancer both in case-control studied [pooled ORs =0.88, 95% confidence interval (CI): 0.78–0.98] and cohort studies (pooled RRs =0.86, 95% CI: 0.86–0.99). In the subgroup analysis, a negative association was observed between the maximal frequency of aspirin use and the endometrial cancer risk (pooled ORs/RRs: 0.82; 95% CI: 0.71–0.95), but no correlations were observed based on the longest duration of aspirin use or obesity.ConclusionsOur results suggest that the use of aspirin was associated with a reduced risk of endometrial cancer, and the reduced risk was closely related to the high-frequency of use. Further randomized controlled trials (RCTs) are needed to confirm these findings.

Effect of aspirin use on gastric cancer incidence and survival: A systematic review and meta-analysis.

Background and AimA number of recent studies have been published evaluating the chemopreventive effect of aspirin against gastric cancer, and an updated meta‐analysis is required to evaluate this relationship further. This study presents a meta‐analysis of studies examining the effect of aspirin on gastric cancer incidence and death.MethodsThe PUBMED and Cochrane Central Registration of Controlled Trials databases were searched for eligible studies published up to December 2018. Pooled risk ratios for gastric cancer incidence and death in aspirin users versus nonusers were determined using fixed‐ and random‐effects models. The influence of the frequency of aspirin use, duration of aspirin use, and geographic location on gastric cancer incidence was evaluated.ResultsThe meta‐analysis comprised 33 studies with a total of 1 927 971 patients. The pooled risk ratios for gastric cancer incidence in the fixed‐ and random‐effects models were 0.890 (95% confidence interval, 0.871–0.909) and 0.826 (0.740–0.922), respectively. In Asia and North America, the maximum preventive benefit of aspirin use was observed with weekly or daily use. Aspirin use was most effective for noncardiac gastric cancer. The pooled risk ratios for gastric cancer death in the fixed‐ and random‐effects models were 0.798 (0.749–0.850) and 0.894 (0.780–1.024), respectively. Significant heterogeneity was observed among studies of gastric cancer incidence but not gastric cancer death.ConclusionAspirin use may reduce the risk of gastric cancer incidence and death; however, the relationship may be limited to a specific frequency and duration of aspirin use and geographic location.

Frequency of aspirin use in patients with type 2 diabetes: Is there any effect of concomitant diseases?

Aim: Current guidelines recommend the use of low-dose aspirin in diabetic patients with increased cardiovascular disease risk with no risk of bleeding to prevent cardiovascular events. The aim of this study was to investigate the frequency of aspirin use in Type 2 Diabetes Mellitus and the effects of concomitant diseases.Material and Methods: Our retrospective and cross-sectional study was planned of data for rate of aspirin use in Type 2 Diabetes mellitus patients. In our study, the socio - demographic characteristics of the participants, their concomitant diseases with Type 2 DM and the drugs they used were questioned. Chi-square test was used for the analysis of categorical variables. P0.05 was considered statistically significant.Results: The mean age of the 910 participants was 57.27±10,00. 64.2% of the participants were female and 35.8% were male. Hypertension was the most common concomitant disease in type 2 DM. The prevalence of aspirin use was found to be %38.6. There is a statistically significant difference between aspirin use rates according to genders (p 0.05). Aspirin use was significantly higher in those who quit smoking and those with concomitant disease with type 2 DM. (p0.05). Conclusion: The rate of aspirin use in our diabetic group was insufficient. In order to increase the use and awareness of aspirin, the factors affecting the use of aspirin should be investigated.

A Prospective Study of Aspirin Use and Prostate Cancer Risk by TMPRSS2:ERG Status.

Background: In a case-control study, aspirin use was associated with a lower risk of a common prostate cancer molecular subtype, the TMPRSS2:ERG gene fusion. We sought to validate this finding in a prospective cohort.Methods: In the Health Professionals Follow-up Study, 49,395 men reported on aspirin use on biennial questionnaires and were followed for prostate cancer incidence over 23 years. TMPRSS2:ERG status was assessed by IHC for presence of ERG on archival tumor specimens for 912 patients with prostate cancer, of whom 48% were ERG-positive.Results: In multivariable models, we found no association between regular use of aspirin and risk of ERG-positive prostate cancer (HR, 1.02; 95% confidence interval, 0.85-1.23), nor any association with duration or frequency of aspirin use. In restricting to cases with either high Gleason grade or advanced stage disease, there remained no association with aspirin use.Conclusions: Data from this prospective study with repeated assessments of aspirin use do not support the hypothesis that aspirin use is associated with a lower risk of ERG-positive prostate cancer.Impact: Aspirin use is unlikely to lower the risk of this common molecular subtype of prostate cancer. However, there is emerging data supporting the role of other lifestyle and genetic factors underlying the development of the TMPRSS2:ERG fusion. Cancer Epidemiol Biomarkers Prev; 27(10); 1231-3. ©2018 AACR.

Aspirin Use and Mortality in Two Contemporary US Cohorts.

Daily aspirin use has been recommended for secondary prevention of cardiovascular disease, but its use for primary prevention remains controversial. We followed 440,277 men and women from the NIH-AARP Diet and Health Study (ages 50-71) and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (ages 55-74) for mortality for 13 years on average. Frequency of aspirin use was ascertained through self-report, and cause of death by death certificates. We calculated multivariate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality using Cox proportional hazards models for each cohort and combined by meta-analysis. We found a consistent U-shaped relationship between aspirin use and mortality in both studies, with differential risk patterns for cardiovascular mortality by disease history. Among individuals with a history of cardiovascular disease, daily aspirin use was associated with reduced cardiovascular mortality [HR = 0.78 (95% CI, 0.74, 0.82)]. However, among those without a previous history, we observed no protection for daily aspirin users [HR = 1.06 (1.02, 1.11)], and elevated risk of cardiovascular mortality for those taking aspirin twice daily or more [HR = 1.29 (1.19, 1.39)]. Elevated risk persisted even among participants who lived beyond 5 years of follow-up and used aspirin without other nonsteroidal antiinflammatory drugs [HR = 1.31 (1.17, 1.47)]. Results from these 2 large population-based US cohorts confirm the utility of daily aspirin use for secondary prevention of cardiovascular mortality; however, our data suggest that caution should be exercised in more frequent use, particularly among individuals without a history of cardiovascular disease.

Aspirin and Risk of Subarachnoid Hemorrhage: Systematic Review and Meta-Analysis.

Recent studies have suggested that the use of low-dose aspirin may reduce the risk of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate any association between aspirin use and risk of aSAH based on the literature, and whether this is influenced by duration or frequency of aspirin use. A search of electronic databases was done from inception to September 2016. For each study, data on risk of aSAH in aspirin versus nonaspirin users were used to generate odds ratios and 95% confidence intervals, and combined using inverse variance-weighted averages of logarithmic odds ratios in a random-effects models. From 7 included studies, no significant difference was noted between aspirin use of any duration or frequency and nonaspirin users (odds ratio, 1.00; 95% confidence interval, 0.81-1.24; P=0.99). We found a significant association between short-term use of aspirin (<3 months) and the risk of aSAH (odds ratio, 1.61; 95% confidence interval, 1.20-2.18; P=0.002). No significant difference was found in terms of risk of aSAH for 3 to 12 months, 1 to 3 years, and >3 years of durations of use. No significant association was found between infrequent aspirin use (≤2× per week) or frequent use (≥3× per week) with risk of aSAH. Current evidence suggests that short-term (<3 months) use of aspirin is associated with increased risk of aSAH. Limitations include substantial heterogenity of the included studies. The role of long-term aspirin in reducing risk of aSAH remains unclear and ideally should be addressed by an appropriately designed randomized controlled trial.

Aspirin as a potential modality for the chemoprevention of breast cancer: A dose-response meta-analysis of cohort studies from 857,831 participants.

BackgroundPrevious meta-analyses on the relationship between aspirin use and breast cancer risk have drawn inconsistent results. In addition, the threshold effect of different doses, frequencies and durations of aspirin use in preventing breast cancer have yet to be established.ResultsThe search yielded 13 prospective cohort studies (N=857,831 participants) that reported an average of 7.6 cases/1,000 person-years of breast cancer during a follow-up period of from 4.4 to 14 years. With a random effects model, a borderline significant inverse association was observed between overall aspirin use and breast cancer risk, with a summarized RR = 0.94 (P = 0.051, 95% CI 0.87-1.01). The linear regression model was a better fit for the dose-response relationship, which displayed a potential relationship between the frequency of aspirin use and breast cancer risk (RR = 0.97, 0.95 and 0.90 for 5, 10 and 20 times/week aspirin use, respectively). It was also a better fit for the duration of aspirin use and breast cancer risk (RR = 0.86, 0.73 and 0.54 for 5, 10 and 20 years of aspirin use).MethodsWe searched MEDLINE, EMBASE and CENTRAL databases through early October 2016 for relevant prospective cohort studies of aspirin use and breast cancer risk. Meta-analysis of relative risks (RR) estimates associated with aspirin intake were presented by fixed or random effects models. The dose-response meta-analysis was performed by linear trend regression and restricted cubic spline regression.ConclusionOur study confirmed a dose-response relationship between aspirin use and breast cancer risk. For clinical prevention, long term (>5 years) consistent use (2-7 times/week) of aspirin appears to be more effective in achieving a protective effect against breast cancer.

Can Aspirin Reduce the Risk of Endometrial Cancer?: A Systematic Review and Meta-analysis of Observational Studies.

Current evidences suggest that nonsteroidal anti-inflammatory drugs can reduce the risk of several types of cancer, including breast, prostate, and colorectal cancer. However, evidences regarding the chemopreventive effect of aspirin to endometrial cancer are inconsistent. Therefore, we aimed to further explore the association. We searched PubMed, EMBASE, Web of Science, and Scopus to identify potentially eligible studies. After title/abstract screening and full-text review, we identified 7 cohort studies and 6 case-control studies. Data extraction and quality assessment were performed independently, and a random-effects model was used for data synthesis. Subgroup analysis was conducted based on obesity, hormone replacement therapy use, and cancer subtype; sensitivity analysis was conducted by pooling risk ratios of the highest dosage or longest duration of use. Dose-response relationship was assessed by a 2-stage linear dose-response model. Statistical heterogeneity was assessed by the I value and a χ test for the Cochrane Q statistic. In overall meta-analysis, the pooled risk ratio was 0.93 (95% confidence interval, 0.88-0.99), and no substantial statistical heterogeneity was observed (I = 0.0%, P = 0.550). In subgroup analysis, a negative association was observed for obese women and type I endometrial cancer. Higher dosage or frequency of aspirin use was significantly associated with a reduced risk, and long-term aspirin use was protective only for obese women. In conclusion, our study suggests that the use of aspirin can reduce the risk of endometrial cancer, particularly for obese women. However, the generalizability of our conclusion should be further studied for premenopausal women and type II endometrial cancer.

Aspirin for Prevention of Subarachnoid Hemorrhage

Aspirin for Prevention of Subarachnoid Hemorrhage

Abstract LB-15: Frequency of aspirin use and prostate cancer mortality among prostate cancer cases in the control arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial.

Abstract Background: Aspirin may slow progression of cancer through the inhibition of platelet aggregation as experimental research has shown that platelets play a role in cancer cell dissemination and metastatic growth. While a 10% reduction in prostate cancer risk has been associated with regular aspirin use, only a few epidemiological studies have evaluated the association between aspirin use and prostate cancer mortality among prostate cancer cases. Methods: Participants included 3857 men, age 55-74, who were diagnosed with prostate cancer in the control arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial between 1993-2009. The frequency of aspirin use one year prior to baseline (1993-2001) was ascertained through a self-administered questionnaire. Death due to prostate cancer was ascertained by annual questionnaire and linkage to the National Death Index. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using COX proportional hazards models using age as the time metric and adjusting for clinical stage, Gleason score, primary treatment, smoking status, body mass index, race, history of heart attack, and history of stroke. Results: After a median of 5 years of follow-up, 136 cases died of prostate cancer. No significant association with prostate cancer mortality was observed between cases who reported pre-diagnostic daily or more than daily aspirin use compared to cases who reported no aspirin use (HR=0.77; 95% CI 0.48-1.25). Among those diagnosed with clinically advanced stage (III, IV) disease, an inverse association with prostate cancer mortality was observed for cases who reported daily or more than daily aspirin use (HR=0.37; 95% CI 0.15-0.92), while no association for daily or more than daily users was seen among those with clinically localized prostate cancer (HR=0.86; 95% CI 0.47-1.58). Conclusion: Pre-diagnostic use of aspirin was not significantly associated with prostate cancer mortality based on cases diagnosed in the PLCO control arm, although a reduction in risk of prostate cancer mortality was observed among those with advanced stage disease in a subgroup analysis. Citation Format: Sarah E. Daugherty, Ruth Pfeiffer, Armen Ghazarian, Grant Izmirlian, Phil Prorok, Katherine McGlynn. Frequency of aspirin use and prostate cancer mortality among prostate cancer cases in the control arm of the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr LB-15. doi:10.1158/1538-7445.AM2013-LB-15

Dose–Risk and Duration–Risk Relationships between Aspirin and Colorectal Cancer: A Meta-Analysis of Published Cohort Studies

BackgroundIn previous meta-analyses, aspirin use has been associated with reduced risk of colorectal cancer. However, uncertainty remains on the exact dose–risk and duration–risk relationships.MethodsWe identified studies by searching several English and Chinese electronic databases and reviewing relevant articles. The dose-response meta-analysis was performed by linear trend regression and restricted cubic spline regression. Subgroup analyses were conducted to explore possible heterogeneity among studies. Potential heterogeneity was calculated as Q statistic and I 2 value. Publication bias was evaluated using funnel plots and quantified by the Begg’s and Egger’s test.ResultsTwelve studies were included in this meta-analysis. An inverse association between aspirin use and colorectal cancer was observed in both the overall group (RR = 0.74, 95% CI 0.64–0.83 for aspirin dose; RR = 0.80, 95% CI 0.75–0.85 for frequency of aspirin use; RR = 0.75, 95% CI 0.68–0.81 for years of aspirin use) and subgroups stratified by sex and cancer site. The dose-response meta-analysis showed that there was a 20% statistically significant decreased risk of colorectal cancer for 325 mg aspirin per day increment, 18% decreased risk for 7 times aspirin per week increment and 18% decreased risk for 10 years aspirin increment.ConclusionLong-term (>5 years), low-dose (75–325 mg per day) and regular aspirin use (2–7 times per week) can effectively reduce the risk of colorectal cancer.

Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials

Long-term follow-up of randomised trials of aspirin in prevention of vascular events showed that daily aspirin reduced the incidence of colorectal cancer and several other cancers and reduced metastasis. However, statistical power was inadequate to establish effects on less common cancers and on cancers in women. Observational studies could provide this information if results can be shown to be reliable. We therefore compared effects of aspirin on risk and outcome of cancer in observational studies versus randomised trials. For this systematic review, we searched for case-control and cohort studies published from 1950 to 2011 that reported associations between aspirin use and risk or outcome of cancer. Associations were pooled across studies by meta-analysis and stratified by duration, dose, and frequency of aspirin use and by stage of cancer. We compared associations from observational studies with the effect of aspirin on 20-year risk of cancer death and on metastasis in the recent reports of randomised trials. In case-control studies, regular use of aspirin was associated with reduced risk of colorectal cancer (pooled odds ratio [OR] 0·62, 95% CI 0·58-0·67, p(sig)<0·0001, 17 studies), with little heterogeneity (p(het)=0·13) in effect between studies, and good agreement with the effect of daily aspirin use on 20-year risk of death due to colorectal cancer from the randomised trials (OR 0·58, 95% CI 0·44-0·78, p(sig)=0·0002, p(het)=0·45). Similarly consistent reductions were seen in risks of oesophageal, gastric, biliary, and breast cancer. Overall, estimates of effect of aspirin on individual cancers in case-control studies were highly correlated with those in randomised trials (r(2)=0·71, p=0·0006), with largest effects on risk of gastrointestinal cancers (case-control studies, OR 0·62, 95% CI 0·55-0·70, p<0·0001, 41 studies; randomised trials, OR 0·54, 95% CI 0·42-0·70, p<0·0001). Estimates of effects in cohort studies were similar when analyses were stratified by frequency and duration of aspirin use, were based on updated assessments of use during follow-up, and were appropriately adjusted for baseline characteristics. Although fewer observational studies stratified analyses by the stage of cancer at diagnosis, regular use of aspirin was associated with a reduced proportion of cancers with distant metastasis (OR 0·69, 95% CI 0·57-0·83, p(sig)<0·0001, p(het)=0·89, five studies), but not with any reduction in regional spread (OR 0·98, 95% CI 0·88-1·09, p(sig)=0·71, p(het)=0·88, seven studies), consistent again with the findings in randomised trials. Observational studies show that regular use of aspirin reduces the long-term risk of several cancers and the risk of distant metastasis. Results of methodologically rigorous studies are consistent with those obtained from randomised controlled trials, but sensitivity is particularly dependent on appropriately detailed recording and analysis of aspirin use. None.

Aspirin as a Promising Agent for Decreasing Incidence of Cerebral Aneurysm Rupture

Chronic inflammation is postulated as an important phenomenon in intracranial aneurysm wall pathophysiology. This study was conducted to determine if aspirin use impacts the occurrence of intracranial aneurysm rupture. Subjects enrolled in the International Study of Unruptured Intracranial Aneurysms (ISUIA) were selected from the prospective untreated cohort (n=1691) in a nested case-control study. Cases were subjects who subsequently had a proven aneurysmal subarachnoid hemorrhage during a 5-year follow-up period. Four control subjects were matched to each case by site and size of aneurysm (58 cases, 213 control subjects). Frequency of aspirin use was determined at baseline interview. Aspirin frequency groups were analyzed for risk of aneurysmal hemorrhage. Bivariable and multivariable analyses were performed using conditional logistic regression. A trend of a protective effect for risk of unruptured intracranial aneurysm rupture was observed. Patients who used aspirin 3× weekly to daily had an OR for hemorrhage of 0.40 (95% CI, 0.18-0.87); reference group, no use of aspirin), patients in the "< once a month" group had an OR of 0.80 (95% CI, 0.31-2.05), and patients in the "> once a month to 2×/week" group had an OR of 0.87 (95% CI, 0.27-2.81; P=0.025). In multivariable risk factor analyses, patients who used aspirin 3 times weekly to daily had a significantly lower odds of hemorrhage (adjusted OR, 0.27; 95% CI, 0.11-0.67; P=0.03) compared with those who never take aspirin. Frequent aspirin use may confer a protective effect for risk of intracranial aneurysm rupture. Future investigation in animal models and clinical studies is needed.

Examining the association between maternal analgesic use during pregnancy and risk of psychotic symptoms during adolescence

Background Children and adolescents who report psychotic symptoms in non-clinical samples are at an increased risk of developing schizophrenia. Study of such ‘high risk’ groups may increase our understanding of early risk factors for psychotic illnesses. Maternal infection during pregnancy is associated with an increased risk of schizophrenia in the offspring, and it has been hypothesised that exposure to maternal intake of analgesics during pregnancy, taken to alleviate the symptoms of viral infections, may partly explain this association. The aim of this study was to examine the relationship between maternal use of aspirin and other analgesics during pregnancy and the occurrence of psychotic symptoms in the offspring. Methods This was a longitudinal study of 6437 children belonging to the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort who participated in the psychosis-like-symptoms semi-structured interview (PLIKSi) at 12 years of age. Data on in-utero exposure to analgesics were obtained from self-report questionnaires completed by the mothers during pregnancy. Results Increasing frequency of aspirin use during pregnancy was associated with an increased risk of psychotic experiences (adjusted OR 1.44, 95% CI 1.08–1.92). Risk was highest in those whose mothers used aspirin most days or daily (adjusted OR 2.79, 95% CI 1.27–6.07). Paracetamol and other analgesic use during pregnancy were not associated with the risk of offspring psychotic symptoms. Conclusions Medications such as aspirin that interfere with the prostaglandin pathway, taken during pregnancy, may influence the risk of schizophrenia in the offspring. Other epidemiological studies are needed to examine this association further.

Non-Steroidal Anti-Inflammatory Drug Use and Colorectal Polyps in the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial

Non-steroidal anti-inflammatory drugs (NSAIDs) have been documented in animal and human studies to reduce risk for colorectal cancer and adenomatous polyps, but risk modification for subgroups of the population and effects on hyperplastic polyps have been less studied. Data on recent use of two frequently ingested NSAIDs, aspirin and ibuprofen, were collected at baseline from participants aged 55-74 years in the 10 centers of the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial (PLCO). Participants randomized to the intervention arm of the trial received a flexible sigmoidoscopy during a baseline examination. Follow-up of detected polyps was accomplished outside the Trial setting and relevant records were sought and abstracted. Cases (n=4,017) included subjects with a biopsy-proven polyp in the left side of the colon (descending colon, sigmoid, and rectum) detected as a consequence of PLCO screening; controls (n=38,396) were subjects with no left-sided colon polyp. Regular use of aspirin (≥ 4 times/month) in the past year was inversely associated with hyperplastic polyps (odds ratios (OR)=0.8, 95% confidence interval (CI)=0.7-0.9), adenomatous polyps (OR=0.8, 95% CI=0.8-0.9), and advanced adenomas (OR=0.8, 95% CI=0.7-0.9). As frequency of aspirin use increased, the prevalence of polyps decreased significantly for each histological classification (P for trend ≤ 0.0004). Similar patterns were found for adenomas and ibuprofen. Overall protection was consistent in both the descending colon or sigmoid and the rectum, but more evident in males. In males, the OR for heavy use of combined aspirin and ibuprofen (≥ 2 times/day) was 0.6 (95% CI=0.5-0.8), as opposed to 0.9 (95% CI=0.8-1.1) in females. The protective effects of NSAIDs for females were apparent only among those with body mass index (BMI) <25 (OR=0.8, 95% CI=0.7-1.0 for regular use of NSAIDs; P interaction=0.04). We also found a slightly stronger protection of NSAIDs in the 70-74 years age group compared with those aged 55-69 years. This study of a large general risk population supports previous work that recent use of aspirin and ibuprofen is associated with a decreased risk of colorectal adenomas and demonstrates that this protective effect may be stronger in certain population subgroups and is also evident for aspirin and hyperplastic polyps.

Abstract 928: Toll-Like Receptor 4 Polymorphisms Modify the Association between T. vaginalis Serostatus and Prostate Cancer Risk

Abstract Background. Our previously study in the Health Professionals Follow-Up Study (HPFS) reported that men who were seropositive for the protozoan Trichomonas vaginalis had a higher risk of prostate cancer (PCa) especially in men who did not regularly take aspirin over their life. In the HPFS, 10 SNPs (rs6478317, rs10116253, rs1927914, rs10759932, rs1927911, rs5030717, rs2149356, rs7873784, rs11536891 and rs1536898) and one haplotype in the innate immune gene, toll-like receptor 4 (TLR4), were significantly associated with decreased PCa risk. As T. vaginalis is recognized by TLR4 on the surface of macrophages, variations in TLR4 may attenuate the inflammatory response towards T. vaginalis and thus modify the risk of PCa. Therefore, we hypothesize that genetic polymorphisms of TLR4 modify the association between T. vaginalis infection and PCa risk, which has not been explored before. Methods. A total of 690 incident PCa cases diagnosed between 1993 and 2000 and 692 matched controls were included in this study nested in the HPFS. We determined T. vaginalis serostatus by ELISA and genotyped 16 common TLR4 SNPs. Logistic regression was used to estimate the association between T. vaginalis seropositivity and PCa by TLR4 genotypes adjusting for potential confounders. Likelihood ratio tests were used to test for interactions. Results. Among men with T. vaginalis seropositivity, non-variant carriers of TLR4 SNPs rs6478317, rs10116253, rs10759932, and rs1927911, were associated with an increased risk of PCa, whereas variant carriers were not associated with PCa (Pinteraction&amp;lt;0.05). Interactions were stronger for high-grade PCa (rs11536858, rs6478317, rs10116253, rs1927914, rs10759932, rs1927911, and rs2149356, Pinteraction&amp;lt;0.05) and much weaker for low-grade PCa (rs10759932, Pinteraction&amp;lt;0.05) than for total PCa for some TLR4 SNPs. Interactions were also stronger among infrequent aspirin users with T. vaginalis seropositivity [rs10116253, rs1927911, rs11536878, rs7873784, and rs11536891, odds ratio (OR)=3.22-6.02, Pinteraction&amp;lt;0.05], and weaker among moderate to regular lifetime aspirin users with T. vagianlis seropositivity (rs10759932, OR=1.54, Pinteraction&amp;lt;0.05). Although the patterns of association between T. vaginalis infection and PCa risk seemed to differ between variant and non-variant carriers of some TLR4 haplotypes, none of these haplotypes significantly modified the association between T. vaginalis serostatus and the risk of total, high- or low-grade PCa. Results remained non-significant after stratification by lifetime frequency of aspirin use. Conclusions. The positive association between T. vaginalis infection and PCa risk was modified by genetic variations in TLR4, and the effect was stronger for high-grade PCa and infrequent aspirin users. Our results support the hypothesis that infection-associated inflammation contributes to the etiology of PCa. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 928.

Nonsteroidal Anti-Inflammatory Drugs and Risk for Ovarian and Endometrial Cancers in the Iowa Women's Health Study

Several epidemiologic studies have shown inverse associations between use of nonsteroidal anti-inflammatory drugs (NSAID) and incident ovarian cancer, but the results are inconsistent. There have been only a few studies examining possible links between NSAIDs and endometrial cancer risk. We investigated associations between use of NSAIDs and incident ovarian and endometrial cancers in a prospective cohort of about 20,000 women with ages from 58 to 76 years in 1992. Participants were asked how often they used aspirin and nonaspirin NSAIDs. Over 15 years, 311 endometrial and 167 ovarian incident malignancies were identified. Multivariate-adjusted hazard ratios were estimated using Cox proportional regression. Compared with women who reported no use of aspirin, the relative risks for ovarian cancer for those who used aspirin <2, 2 to 5 times, and > or = 6 times per week were 0.83, 0.77, and 0.61, respectively (P trend = 0.04). We did not observe any association between nonaspirin NSAIDs use and ovarian cancer risk. Neither did we find associations between aspirin or nonaspirin NSAIDs use and risk for endometrial cancer. Our results suggest a possible inverse association between frequency of aspirin use and risk for ovarian cancer.

Anti-platelet therapy in diabetic hypertensive patients with and without cardiovascular diseases in Palestine, from 2003 to 2008

Summary Objective To determine the current frequency of anti-platelet use as indicated in medical charts of diabetic hypertensive patients with and without cardiovascular disease (CVD) using American Diabetes Association (ADA) guidelines compared with use in 2003. Methodology Data from both years were collected retrospectively from diabetic hypertensive patients attending government clinics in Nablus district, Palestine. Demographic details and medications were obtained from medical files. Diabetes mellitus and hypertension were confirmed based on documentation of the diagnosis and on listed anti-diabetic and anti-hypertensive medications. Eligibility for anti-platelet therapy was determined with reference to ADA guidelines. Results There were 358 patients included in the 2008 study with a mean age of 64.4years. The mean age of the 342 patients included in the 2003 study was 64.4±8.7years. Aspirin was the only anti-platelet drug documented in the files in both years. The overall frequency of aspirin listed in 2008 was 66.5% compared to 31.5% in 2003. Among patients with CVD, aspirin therapy for secondary prevention (SP) was found in 77.9% of cases in 2008 compared to 82.4% in 2003 ( P =0.23). Among patients without CVD for whom anti-platelet therapy was indicated, aspirin was listed for primary prevention (PP) in 56.9% of cases in 2008 compared to 17.5% in 2003 ( P =0.001). In 2008, the frequency of aspirin use was independent of gender or age. However, in 2003, the frequency of aspirin use was significantly higher in men and younger patients than in women and elderly patients. Conclusion There has been an improvement in anti-platelet therapy using aspirin for primary prevention among high risk patients. No significant change was observed for secondary prevention over the five years. Efforts are needed to enhance the use of aspirin particularly for cardiovascular patients requiring secondary prevention.

Regular aspirin use and retinal microvascular signs: the Blue Mountains Eye Study

Hypertension is closely related to microvascular abnormalities and there is increasing interest in agents that target the microvasculature. The effect of aspirin on the microvasculature has not been well studied. We examined the cross-sectional and longitudinal associations between regular aspirin use and retinal microvascular signs. We digitized retinal photographs from participants of the Blue Mountains Eye Study cohort (1992-1994, n = 3654, aged over 49 years, and 1997-1999, n = 2335) and used a computer-assisted method to measure average retinal arteriolar and venular diameters. Information on the frequency of aspirin use was collected, with regular aspirin use defined as weekly or daily. Regular aspirin users comprised 21.2% (n = 775) of the baseline population. At baseline and in individuals who were on one or more antihypertensive medication, regular aspirin use was found to be associated with retinal arterioles on average 3.6 mum (95% confidence interval 1.0, 6.2) wider than those of non-users or occasional aspirin users, after adjusting for age, blood pressure, smoking, diabetes, non-steroidal anti-inflammatory drug use and other variables. Increasing frequency of aspirin use was associated with increasing retinal arteriolar diameter (Ptrend < 0.01). At 5-year follow-up, regular users of aspirin and antihypertensive medication(s) had wider retinal arterioles than those who used aspirin less regularly. Neither antihypertensive medication use alone nor aspirin use alone was associated with wider retinal vessels. Our finding of a possible association between the combined use of aspirin and antihypertensive agent(s) and wider retinal arteriolar diameter warrants further investigation into the effects of aspirin on the microvasculature.