ImportanceAspirin reduces the risk of colorectal cancer (CRC). Identifying individuals more likely to benefit from regular aspirin use for CRC prevention is a high priority.ObjectiveTo assess whether aspirin use is associated with the risk of CRC across different lifestyle risk factors.Design, Setting, and ParticipantsA prospective cohort study among women in the Nurses’ Health Study (1980-2018) and men in the Health Professionals Follow-Up Study (1986-2018) was conducted. Data analysis was performed from October 1, 2021, to May 22, 2023.ExposuresA healthy lifestyle score was calculated based on body mass index, alcohol intake, physical activity, diet, and smoking with scores ranging from 0 to 5 (higher values corresponding to a healthier lifestyle). Regular aspirin use was defined as 2 or more standard tablets (325 mg) per week.Main Outcome and MeasuresOutcomes included multivariable-adjusted 10-year cumulative incidence of CRC, absolute risk reduction (ARR), and number needed to treat associated with regular aspirin use by lifestyle score and multivariable-adjusted hazard ratios for incident CRC across lifestyle scores.ResultsThe mean (SD) baseline age of the 107 655 study participants (63 957 women from the Nurses’ Health Study and 43 698 men from the Health Professionals Follow-Up Study) was 49.4 (9.0) years. During 3 038 215 person-years of follow-up, 2544 incident cases of CRC were documented. The 10-year cumulative CRC incidence was 1.98% (95% CI, 1.44%-2.51%) among participants who regularly used aspirin compared with 2.95% (95% CI, 2.31%-3.58%) among those who did not use aspirin, corresponding to an ARR of 0.97%. The ARR associated with aspirin use was greatest among those with the unhealthiest lifestyle scores and progressively decreased with healthier lifestyle scores (P < .001 for additive interaction). The 10-year ARR for lifestyle scores 0 to 1 (unhealthiest) was 1.28%. In contrast, the 10-year ARR for lifestyle scores 4 to 5 (healthiest) was 0.11%. The 10-year number needed to treat with aspirin was 78 for participants with lifestyle scores 0 to 1, 164 for score 2, 154 for score 3, and 909 for scores 4 to 5. Among the components of the healthy lifestyle score, the greatest differences in ARR associated with aspirin use were observed for body mass index and smoking.Conclusions and RelevanceIn this cohort study, aspirin use was associated with a greater absolute reduction in risk of CRC among individuals with less healthy lifestyles. The findings of the study suggest that lifestyle risk factors may be useful to identify individuals who may have a more favorable risk-benefit profile for cancer prevention with aspirin.

中文翻译：

---

根据生活方式风险的阿司匹林使用和结直肠癌发病率


重要性阿司匹林可降低患结直肠癌 （CRC） 的风险。确定更有可能从定期使用阿司匹林预防 CRC 中受益的个体是一个高度优先事项。目的评估阿司匹林的使用是否与不同生活方式危险因素的 CRC 风险相关。设计、设置和参与者对护士健康研究 （1980-2018） 中的女性和卫生专业人员随访研究 （1986-2018） 中的男性进行了一项前瞻性队列研究。数据分析于 2021 年 10 月 1 日至 2023 年 5 月 22 日进行。暴露根据体重指数、酒精摄入量、身体活动、饮食和吸烟计算健康生活方式评分，评分范围为 0 到 5（较高的值对应于更健康的生活方式）。常规使用阿司匹林定义为每周 2 片或更多标准片剂 （325 mg）。主要结局和测量结局包括多变量调整的 CRC 10 年累积发生率、绝对风险降低 （ARR） 和与定期使用阿司匹林相关的需要治疗的人数（按生活方式评分）和多变量调整风险比（按生活方式评分）新发 CRC。结果107 655 名研究参与者（护士健康研究中的 63 957 名女性和卫生专业人员随访研究中的 43 698 名男性）的平均 （SD） 基线年龄为 49.4 （9.0） 岁。在 3 038 215 人年的随访期间，记录了 2544 例 CRC 事件病例。经常使用阿司匹林的参与者的 10 年累积 CRC 发生率为 1.98% （95% CI，1.44%-2.51%），而不使用阿司匹林的参与者为 2.95% （95% CI，2.31%-3.58%），对应的 ARR 为 0.97%。 与阿司匹林使用相关的 ARR 在生活方式评分最不健康的人群中最大，并且随着更健康的生活方式评分而逐渐降低（P < .001 对于加互作用）。生活方式评分 0 到 1（最不健康）的 10 年 ARR 为 1.28%。相比之下，生活方式评分 4 至 5（最健康）的 10 年 ARR 为 0.11%。生活方式评分为 0 至 1 分的参与者需要用阿司匹林治疗的 10 年数为 78,2 分为 164,3 分为 154,4 至 5 分为 909。在健康生活方式评分的组成部分中，观察到体重指数和吸烟与阿司匹林使用相关的 ARR 差异最大。结论和相关性在这项队列研究中，阿司匹林的使用与生活方式较差的个体患 CRC 风险的绝对降低幅度更大有关。研究结果表明，生活方式风险因素可能有助于识别可能具有更有利的阿司匹林预防癌症风险收益特征的个体。