I haven’t read the whole paper, but I also wanted to see what aspirin’s effect on all causes of death was. (I wondered whether the higher risk of bleeding would offset the lower risk of cancer; it didn’t.) The magic keywords to Ctrl-F for are “all-cause”.
p. 34:
The reduction in cancer deaths on aspirin during the trials resulted in lowered in-trial all-cause mortality (10.2% vs 11.1%, OR 0.92, 0.85–1.00, p=0.047, webappendix p 4), even though other deaths were not reduced (0.98, 0.89–1.07, p=0.63).
p. 36:
In patients with scheduled duration of trial treatment of 5 years or longer, all-cause mortality was reduced at 15 years’ follow-up (HR 0·92, 0·86–0·99, p=0·03), due entirely to fewer cancer deaths, but this effect was no longer seen at 20 years (0·96, 0·90–1·02, p=0·37). However, the effect on post-trial deaths was diluted by a transient increase in risk of vascular death in the aspirin groups during the first year after completion of the trials (75 observed vs 46 expected, OR 1·69, 1·08–2·62, p=0·02), presumably due to withdrawal of trial aspirin.
p. 39:
Fourth, we were unable to determine the effect of long-term (eg, 20–30 years) continued aspirin use on cancer death or all-cause mortality because of the finite duration of the trials.
and
Our analyses show that taking aspirin daily for 5–10 years would reduce all-cause mortality (including any fatal bleeds) during that time by about 10% (relative risk reduction). Subsequently, there would be further delayed reductions in risk of cancer death, but no continuing excess risk of bleeding.
The big caveat I have in light of this is that the trial patients were in their 40s and older. I would guess the cost-benefit balance tilts the other way for sufficiently young people because younger people have a lower risk of cancer or CVD.
I haven’t read the whole paper, but I also wanted to see what aspirin’s effect on all causes of death was. (I wondered whether the higher risk of bleeding would offset the lower risk of cancer; it didn’t.) The magic keywords to Ctrl-F for are “all-cause”.
p. 34:
p. 36:
p. 39:
and
The big caveat I have in light of this is that the trial patients were in their 40s and older. I would guess the cost-benefit balance tilts the other way for sufficiently young people because younger people have a lower risk of cancer or CVD.