Long-term use of daily, low-dose aspirin did not affect the risk of dementia or mental decline in adults with type 2 diabetes, based on findings from the ASCEND trial presented Nov. 15 during AHA 2021.

Researchers randomized 15,480 adult patients with type 2 diabetes in the UK (average age 63 years; 63% were male) who had not experienced a stroke, heart attack or other cardiovascular issue, to receive a single 100 mg aspirin daily or placebo. None of the participants had dementia at the start of the study. All participants were tracked for approximately nine years, with an average seven years of treatment and two years of follow-up.

Overall findings showed 1,146 participants experienced broad dementia at follow-up and were prescribed dementia medications or received a referral to a memory clinic or geriatric psychiatry.

“The results show no clear effect of daily low-dose aspirin on the risk of dementia, with a non-significant 9% proportional reduction in risk. However, the uncertainty around this 9% benefit ranged from a 19% reduction in dementia risk to a 2% increase. This is reassuring that an increase in the risk of dementia is unlikely for the millions of people worldwide who regularly take aspirin to protect against the risk of heart attack and stroke,” said Jane Armitage, MBBS, who presented the findings on behalf of the investigators with Sarah Parish, MD.

In other findings, however, researchers did note an association of serious vascular events, with dementia. The 990 study participants who experienced a major vascular event were almost two and a half times more likely to experience dementia, memory loss, confusion or mental decline during the study compared with participants who did not have a major vascular event. Similarly, the 496 participants who survived a major bleed event were twice as likely to experience dementia, memory loss, confusion or mental decline than those who did not have a bleed.

“The results mean a modest benefit of daily low-dose aspirin on risk of dementia is possible, however, we need studies with more people developing dementia to be sure,” said Armitage. “A larger study with more cases of dementia may be able to detect any benefits or harms. We plan to continue to follow the trial participants for several more years to see if more cases of dementia emerge.”

The 2019 ACC/AHA Primary Prevention Guideline recommends that adults without known cardiovascular disease only take aspirin for heart attack and stroke prevention if they have the highest risk of cardiovascular disease and a very low risk of bleeding. Recently released draft guidance from the U.S. Preventive Services Task Force includes similar recommendations. However, adults with previously diagnosed cardiovascular disease or a previous cardiac event such as a heart attack or stroke, should continue to take daily low-dose aspirin if prescribed by their physician.

Clinical Topics: Geriatric Cardiology, Prevention, Stable Ischemic Heart Disease, Chronic Angina

Keywords: AHA Annual Scientific Sessions, American Heart Association, AHA21, Angina, Stable, Aspirin, Primary Prevention, Geriatrics

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