# Health Outcomes of Discontinuing Aspirin in Older Adults with Alzheimer's Disease and Related Dementias

> **NIH NIH R01** · UNIV OF NORTH CAROLINA CHAPEL HILL · 2024 · $617,564

## Abstract

PROJECT SUMMARY/ABSTRACT
Reducing polypharmacy by discontinuing medications with reduced benefits and increased risks is a priority in
older adults (OAs) with Alzheimer’s Disease and Related Dementias (ADRD). Low-dose aspirin for primary or
secondary prevention of atherosclerotic cardiovascular disease (ASCVD) has been proposed as a target for
discontinuation, with limited real-world data suggesting high variation in prescribing and discontinuation.
Guidelines recommend against aspirin for primary prevention in OAs, while supporting its use for secondary
prevention; however, applicability to OAs with ADRD is questionable. Reduced life expectancy for OAs with
ADRD may translate into lower long-term ASCVD benefits, while increased potential for drug interactions may
increase short-term bleeding risk. On the other hand, higher ASCVD risk among OAs with ADRD may position
them for greater risk of ASCVD events previously observed in other populations in weeks after discontinuing
aspirin, and the anti-inflammatory and anti-thrombotic effects of aspirin could also protect against further
progression of cognitive or functional decline. The exclusion of OAs with ADRD from randomized trials of
aspirin and limited availability of observational data on aspirin use (a non-prescription drug) leaves patients,
providers, and caregivers with little evidence about benefits and harms to guide informed decisions about
aspirin discontinuation. Our long-term goal is to improve decision-making, care quality, and outcomes for OAs
with ADRD, through improved evidence and treatment guidelines about medications optimization as ADRD
progresses. The proposed retrospective cohort study will use records on daily aspirin use uniquely
available for a national cohort of Veterans Affairs (VA) nursing home (NH) residents with ADRD, linked to
Minimum Data Set (MDS) assessments, electronic health records, and VA and Medicare utilization data over
2016-2023. Specific aims are to (1) Identify clinical and socio-environmental factors predicting aspirin
discontinuation in OAs with ADRD after NH admission, stratified by ASCVD status; (2) Examine effects of
discontinuing aspirin on ASCVD events, major bleeding, emergency department/hospital admissions, and
mortality, stratified by ASCVD status; and (3) Examine effects of discontinuing aspirin on cognitive function,
functional dependence, and behavioral/psychological symptoms of dementia. To focus our aims on generating
robust, clinically- and policy-relevant evidence, we will use pharmacoepidemiologic methods to reduce
selection bias and confounding. Aim 2 is a prevalent new-user study applying covariate balancing methods and
competing risk models, with supplementary analyses to address time-varying aspirin exposure and
confounders. Aim 3 will assess time-varying exposures and confounding using inverse-probability-weighted
marginal structural models. This study will inform future practice guidelines to address if aspirin can be safely
disco...

## Key facts

- **NIH application ID:** 10828001
- **Project number:** 5R01AG079219-02
- **Recipient organization:** UNIV OF NORTH CAROLINA CHAPEL HILL
- **Principal Investigator:** Carolyn Timberlake Thorpe
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $617,564
- **Award type:** 5
- **Project period:** 2023-04-15 → 2027-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10828001

## Citation

> US National Institutes of Health, RePORTER application 10828001, Health Outcomes of Discontinuing Aspirin in Older Adults with Alzheimer's Disease and Related Dementias (5R01AG079219-02). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10828001. Licensed CC0.

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