Key result
Low-dose aspirin reduced colorectal cancer risk and increased upper gastrointestinal bleeding risk, and these effects were not modified by bodyweight or BMI.
Why the study?
Trial meta-analysis suggested bodyweight modifies low-dose aspirin's effects on colorectal cancer and major bleeding in primary CVD prevention, but whether this occurs in routine practice remained unknown.
Does low-dose aspirin reduce colorectal cancer and increase gastrointestinal bleeding across different bodyweight and BMI strata in primary care patients?
Cohort (n=400,000)
Does low-dose aspirin reduce colorectal cancer and increase gastrointestinal bleeding across different bodyweight and BMI strata in primary care patients?
Relative Risk: 0.6 (95% CI 0.5–0.72)
In routine clinical practice, the efficacy of low-dose aspirin in reducing colorectal cancer risk and its harm in increasing upper gastrointestinal bleeding risk are consistent regardless of patient bodyweight or BMI.
No bodyweight-based dosing adjustment warranted for low-dose aspirin CRC prevention or UGIB risk in practice; leaves open reconciliation with prior trial meta-analyses.
Background Meta-analysis of trial data suggests that in primary cardiovascular disease (CVD) prevention bodyweight modifies low-dose aspirin's effects on colorectal cancer (CRC) and major bleeding risk. We sought to investigate whether these effects are seen in patients with or without CVD in routine clinical practice by undertaking sub-analyses of data from two cohort studies with nested-case-control analyses. Methods We followed ~200,000 new users of low-dose aspirin (75–300 mg/day) and a matched cohort of non-users to identify incident cases of CRC/upper gastrointestinal bleeding (UGIB). Adjusted relative risks (RRs) with 95% confidence intervals (CIs) were calculated for current vs. non-use of low-dose aspirin using logistic regression stratified by bodyweight/body mass index (BMI) strata. Results RRs (95% CIs) for CRC by bodyweight were: 0.60 (0.50–0.72) for ≤70 kg, 0.68 (0.60–0.76) for >70 kg; and by BMI were 0.60 (0.52–0.68) for ≤28 kg/m 2 , 0.76 (0.64–0.89) for >28 kg/m 2 . For UGIB, estimates were: 1.49 (1.28–1.74) for ≤90 kg, 1.78 (1.29–2.45) for >90 kg/m 2 , 1.44 (1.21–1.72) for ≤28 kg/m 2 , 1.72 (1.38–2.16) for >28 kg/m 2 . Results were similar in the primary CVD prevention population. Conclusion Our findings suggest that the effects of low-dose aspirin in reducing CRC risk and increasing UGIB risk are not modified by bodyweight/BMI.
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Soriano et al. (2019) conducted a cohort in Cardiovascular disease prevention (n=400,000). Low-dose aspirin vs. Non-users was evaluated on Colorectal cancer (CRC) in patients ≤70 kg (RR 0.60, 95% CI 0.50-0.72). Low-dose aspirin reduced colorectal cancer risk and increased upper gastrointestinal bleeding risk, and these effects were not modified by bodyweight or BMI.
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