3437 Associations of aspirin, non-aspirin NSAIDs, statins, and metformin with risk of biliary cancer: A Swedish population-based cohort study

OBJECTIVES/SPECIFIC AIMS: In an effort to elucidate the role of potentially cancer chemopreventive drugs, we leveraged the Mayo Clinic-Karolinska Institute collaboration to create a multidisciplinary team that included an epidemiologist, statisticians, and physicians. We performed a population-based cohort study to examine the association between low dose aspirin, non-aspirin NSAIDs, statins, metformin, other risk factors and the risk of biliary tract cancer (BTC), while assessing confounding by sex. METHODS/STUDY POPULATION: We conducted a nationwide Swedish population-based cohort study using the Swedish Prescribed Drug Registry, which virtually completely enumerates use of prescribed medications nationwide since 2005. BTC diagnosis (intrahepatic cholangiocarcinoma [iCCA], extrahepatic cholangiocarcinoma [eCCA] or gallbladder cancer [GBC]) was ascertained from the Swedish Cancer Registry. Age-scaled Cox models, with exposure as time-varying covariates, were used to calculate hazard ratios (HRs), separately for men and women. RESULTS/ANTICIPATED RESULTS: In the 5.7 million person cohort, the risk of iCCA was significantly lower in men using statins (HR 0.62,95%CI 0.39-1.00, p = 0.05), with a non-significant reduction in women. Statin use was associated with a significantly decreased risk of eCCA in both women (HR 0.60,0.38-0.94, p = 0.03) and men (HR 0.47,0.28-0.80, p = 0.01). Low dose aspirin (HR 0.76,0.60-0.97, p = 0.03) was associated with a lower risk of GBC only in women, while statins (HR 0.72,0.55-0.93, p = 0.01) showed a significantly decreased risk of GBC in women and a non-significant reduction in men. For all BTC subtypes, combined use of low dose aspirin and statins did not confer additional risk reductions beyond those achieved by statins alone. Male and female users of non-aspirin NSAIDs appeared to be at increased risk of BTC and its subtypes. Metformin did not significantly affect risk of BTC. DISCUSSION/SIGNIFICANCE OF IMPACT: Our collaborative efforts allowed us to develop the largest population-based cohort evaluating risk and protective factors for BTC. Our results provide strong evidence in favor of the chemopreventive roles of low dose aspirin and statins in a subtype- and sex-specific manner. Individual risk factors contribute to development of BTC subtypes in different magnitudes. The next steps to translate these findings into clinical practice require randomized clinical trials that validate our results and provide a more complete picture of the risk-benefit ratio.

Download Full-text

PO-19 Initiation of low-dose aspirin and risk of colorectal neoplasms: a population-based matched cohort study in Denmark

Thrombosis Research ◽

10.1016/s0049-3848(21)00192-4 ◽

2021 ◽

Vol 200 ◽

pp. S26

Author(s):

E. Schønfeldt Troelsen ◽

D. Körmendiné Farkas ◽

R. Erichsen ◽

T. Sørensen

Keyword(s):

Cohort Study ◽

Colorectal Neoplasms ◽

Low Dose ◽

Population Based ◽

Matched Cohort ◽

Matched Cohort Study ◽

Dose Aspirin ◽

Low Dose Aspirin

Download Full-text

Low-dose aspirin and survival from lung cancer: a population-based cohort study

BMC Cancer ◽

10.1186/s12885-015-1910-9 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 12

Author(s):

Úna C. Mc Menamin ◽

Chris R. Cardwell ◽

Carmel M. Hughes ◽

Liam M. Murray

Keyword(s):

Lung Cancer ◽

Cohort Study ◽

Low Dose ◽

Population Based ◽

Dose Aspirin ◽

Low Dose Aspirin

Download Full-text

Comparing mortality of colorectal cancer and gastrointestinal bleeding among patients with long-term use of low dose aspirin: A population-based study of 689,209 patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.527 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 527-527

Author(s):

Joseph Sung ◽

Kelvin Kf Tsoi

Keyword(s):

Colorectal Cancer ◽

Gastrointestinal Bleeding ◽

Large Scale ◽

Low Dose ◽

Population Based ◽

Dose Aspirin ◽

Increased Risk ◽

Incidence And Mortality ◽

Low Dose Aspirin

527 Background: Aspirin, commonly used for prevention of cardiovascular and cerebrovascular diseases, is well-known to protect against colorectal cancer (CRC) development but increase risk of gastrointestinal bleeding (GIB). Few large-scale studies have compared the benefit and risk of long-term aspirin usage. This cohort study aims to evaluate the use of low-dose aspirin to prevent CRC and the risk of GIB associated with the aspirin use. Methods: A population-based clinical dataset was used to compare incidence and mortality of CRC and GIB patients receiving low-dose aspirin with sex-and-age matched controls (in 1:2 ratio). Patients with aspirin≤6 months were excluded. Clinical data of 206,243 aspirin users (mean dose 80 mg/day, mean duration 7.7 years) and 482,966 non-users were included. All patients must have at least 10-year follow up on clinical outcome. Results: Among aspirin users 5,776 (2.80%) were diagnosed with CRC; 2,097 (1.02%) died of the malignancy. 16,483 (3.41%) non-users were diagnosed with CRC; 7,963 (1.65%) died of CRC. Using the cox-proportional hazard regression, aspirin usage showed a modest but significant reduction in CRC mortality (HR = 0.65; 95% CI = 0.62 to 0.69). On the other hand, 11,187 (5.42%) aspirin users developed GIB, and 841 (0.41%) died. 15,186 (3.14%) non-users developed GIB, and 1,682 patients (0.35%) died. Aspirin users showed modest but significant increased risk of GIB-related mortality (HR = 1.24; 95% CI = 1.14 to 1.35). Conclusions: The long-term use of low dose aspirin shows preventive effect on CRC, but also increases the associated GIB risk. Considerations of prophylactic use of aspirin should balance the benefit and the risk of this treatment to the target population. [Table: see text]

Download Full-text

PO-54 Venous thromboembolism and risk of cancer in users of low-dose aspirin: a Danish population-based cohort study

Thrombosis Research ◽

10.1016/s0049-3848(21)00227-9 ◽

2021 ◽

Vol 200 ◽

pp. S45

Author(s):

F. Schønfeldt Troelsen ◽

D. Nagy ◽

N. Skajaa ◽

D. Körmendiné Farkas ◽

R. Erichsen ◽

...

Keyword(s):

Cohort Study ◽

Venous Thromboembolism ◽

Low Dose ◽

Population Based ◽

Danish Population ◽

Dose Aspirin ◽

Low Dose Aspirin ◽

Risk Of Cancer

Download Full-text

A population-based cohort study of the risk of colorectal and other cancers among users of low-dose aspirin

British Journal of Cancer ◽

10.1038/sj.bjc.6600760 ◽

2003 ◽

Vol 88 (5) ◽

pp. 684-688 ◽

Cited By ~ 110

Author(s):

S Friis ◽

H T Sørensen ◽

J K McLaughlin ◽

S P Johnsen ◽

W J Blot ◽

...

Keyword(s):

Cohort Study ◽

Low Dose ◽

Population Based ◽

Dose Aspirin ◽

Low Dose Aspirin

Download Full-text

Low-dose aspirin and risk of intracranial bleeds

Neurology ◽

10.1212/wnl.0000000000004694 ◽

2017 ◽

Vol 89 (22) ◽

pp. 2280-2287 ◽

Cited By ~ 21

Author(s):

Lucía Cea Soriano ◽

David Gaist ◽

Montse Soriano-Gabarró ◽

Susan Bromley ◽

Luis A. García Rodríguez

Keyword(s):

Low Dose ◽

Reference Group ◽

Population Based ◽

The United Kingdom ◽

Dose Aspirin ◽

Increased Risk ◽

Low Dose Aspirin ◽

Adjusted Rate ◽

Rate Ratios ◽

Incident Cases

Objective:To quantify the risk of intracranial bleeds (ICBs) associated with new use of prophylactic low-dose aspirin using a population-based primary care database in the United Kingdom.Methods:A cohort of new users of low-dose aspirin (75–300 mg; n = 199,079) aged 40–84 years and a 1:1 matched cohort of nonusers of low-dose aspirin at baseline were followed (maximum 14 years, median 5.4 years) to identify incident cases of ICB, with validation by manual review of patient records or linkage to hospitalization data. Using 10,000 frequency-matched controls, adjusted rate ratios (RRs) with 95% confidence intervals (CIs) were calculated for current low-dose aspirin use (0–7 days before the index date [ICB date for cases, random date for controls]); reference group was never used.Results:There were 1,611 cases of ICB (n = 743 for intracerebral hemorrhage [ICH], n = 483 for subdural hematoma [SDH], and n = 385 for subarachnoid hemorrhage [SAH]). RRs (95% CI) were 0.98 (0.84–1.13) for all ICB, 0.98 (0.80–1.20) for ICH, 1.23 (0.95–1.59) for SDH, and 0.77 (0.58–1.01) for SAH. No duration of use or dose–response association was apparent. RRs (95% CI) for ≥1 year of low-dose aspirin use were 0.90 (0.72–1.13) for ICH, 1.20 (0.91–1.57) for SDH, and 0.69 (0.50–0.94) for SAH.Conclusion:Low-dose aspirin is not associated with an increased risk of any type of ICB and is associated with a significantly decreased risk of SAH when used for ≥1 year.

Download Full-text

Association Between Aspirin Use and Decreased Risk of Pneumonia in Patients With Cardio-Cerebra-Vascular Ischemic Disease: A Population-Based Cohort Study

Frontiers in Public Health ◽

10.3389/fpubh.2021.625834 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ying-Cheng Chen ◽

Yin-Yang Chen ◽

Han Wei Yeh ◽

Tung-Ying Yeh ◽

Jing-Yang Huang ◽

...

Keyword(s):

Cohort Study ◽

Low Dose ◽

Population Based ◽

Hazard Ratio ◽

Cumulative Probability ◽

Research Database ◽

Cox Regression Analysis ◽

Dose Aspirin ◽

Low Dose Aspirin

This study evaluated the association between long-term low-dose aspirin use and decreased risk of pneumonia in patients with cardio-cerebra-vascular ischemic diseases (CCVDs). This retrospective cohort study used records from Taiwan's National Health Insurance Research Database of claims made between 1997 and 2013. After propensity score matching (PSM), patients who took a low dose of aspirin for more than 90 days within 1 year of diagnosis with CCVDs were identified as the exposure group (n = 15,784). A matched total of 15,784 individuals without aspirin use were selected for the non-aspirin group. The main outcome was the development of pneumonia after the index date. Multivariable Cox regression analysis and Kaplan–Meier survival analysis were performed to estimate the adjusted hazard ratio (aHR) and cumulative probability of pneumonia. The result after PSM indicated a lower hazard ratio for pneumonia in aspirin users (aHR = 0.890, 95% confidence interval = 0.837–0.945). Therefore, patients with CCVDs who took aspirin had a lower risk of developing pneumonia than those who did not. In conclusion, this population-based cohort study demonstrated that long-term low-dose aspirin use is associated with a slightly decreased risk of pneumonia in patients with CCVDs.

Download Full-text