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In this post hoc analysis of the ASCEND trial including 15,427 patients with diabetes but without cardiovascular disease and dementia at baseline, the overall incidence of broad dementia (dementia, cognitive impairment, or confusion) was similar regardless of randomization to aspirin or placebo (rate ratio, 0.91). This result was affirmed 2 years beyond the scheduled treatment period.
Overall, aspirin did not appear to have a large proportional effect on the risk of dementia. Meta-analyses or larger trials would be needed to clarify whether any modest proportional benefits exist between long-term aspirin use and dementia risk.
Aspirin is widely used in cardiovascular disease prevention but is also associated with an increased risk of bleeding. The net effect of aspirin on dementia and cognitive impairment is uncertain.
METHODS AND RESULTS
In the ASCEND trial, 15 480 people from the UK with diabetes and no history of cardiovascular disease were randomized to aspirin 100 mg daily or matching placebo for a mean of 7.4 years. The 15 427 ASCEND participants with no recorded dementia prior to baseline were included in this cognitive study with a primary pre-specified outcome of 'broad dementia', comprising dementia, cognitive impairment, or confusion. This was ascertained through participant, carer, or general practitioner report or hospital admission diagnosis, by 31 March 2019 (∼2 years beyond the scheduled treatment period). The broad dementia outcome occurred in a similar percentage of participants in the aspirin group and placebo group: 548 participants (7.1%) vs. 598 (7.8%), rate ratio 0.91 [95% confidence interval (CI), 0.81-1.02]. Thus, the CI excluded proportional hazards of >2% and proportional benefits of >19%.
Aspirin does not have a large proportional effect on the risk of dementia. Trials or meta-analyses with larger total numbers of incident dementia cases to increase statistical power are needed to assess whether any modest proportional 10-15% benefits of 5-7 years of aspirin use on dementia exist.