Low-dose aspirin prevents various forms of dementia in Coronary heart disease patients

A new study conducted by Thi Ngoc Mai Nguyen and team shows the preventive potential of low-dose acetylsalicylic acid (ASA) against dementia, Alzheimer's disease (AD), and vascular dementia (VD) appears to be largely dependent on pre-existing coronary heart disease (CHD). The findings of this study were published in The BMC Journal of Alzheimer's Research & Therapy.

So far, no population-based cohort research has looked at a possible inverse relationship between long-term low-dose acetylsalicylic acid usage and all-cause dementia or its two most frequent subtypes, Alzheimer's disease and vascular dementia. Using data from two major, population-based cohorts with more than ten years of follow-up, this study explored the connection of low-dose ASA with all-cause dementia, AD, and VD incidence.

For this study, cox regression models with inverse probability of treatment weighting were used to assess the associations of low-dose ASA use with all-cause dementia, Alzheimer's disease, and cardiovascular disease incidence in community-dwelling older individuals from the German ESTHER study (N = 5258) and the UK Biobank (N = 305,394). Inclusion requirements included being 55 or older and having undergone a drug test. Individual participant records from the two prospective cohort studies were meta-analyzed.

The key findings of this study were as follow:

1. Over a median of 14.3 years of follow-up, 476 instances of all-cause dementia, 157 cases of AD, and 183 cases of VD were identified in ESTHER.

2. Over a median of 11.6 years, 5584 people in the UK Biobank were diagnosed with all-cause dementia, 2029 with AD, and 1437 with VD.

3. The meta-analysis of both cohorts demonstrated a marginal decrease in the risk of all-cause dementia. Low-dose ASA had the greatest preventive benefit in people with coronary heart disease both in cohorts, and a significant association was seen.

4. In particular, a 31% reduction in the risk of AD, a 69% reduction in the risk of VD, and a 34% reduction in the risk of all-cause dementia was reported in a meta-analysis.

5. Furthermore, consumers of low-dose ASA for 10 years or longer had a considerable protective impact on all dementia outcomes, particularly VD, as compared to non-users, although no beneficial correlations were identified with shorter low-dose ASA usage.

The PI concluded that the outcomes of this study suggest that persons with CHD may benefit from long-term low-dose ASA usage not just by lowering their CVD risk, but also by lowering their dementia risk. The findings of this study can only be extrapolated to primarily Caucasian populations aged 55 and older, and they must be validated in RCTs with high sample numbers and lengthy follow-up periods.

Reference:

Nguyen, T. N. M., Chen, L.-J., Trares, K., Stocker, H., Holleczek, B., Beyreuther, K., Brenner, H., & Schöttker, B. (2022). Long-term low-dose acetylsalicylic use shows protective potential for the development of both vascular dementia and Alzheimer's disease in patients with coronary heart disease but not in other individuals from the general population: results from two large cohort studies. In Alzheimer's Research & Therapy (Vol. 14, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13195-022-01017-4