TOPLINE:
Healthy older adults who received aspirin experienced no significant long-term benefits against major adverse cardiovascular events (MACE); the rates of major hemorrhage were higher among users of aspirin than among users of placebo.
METHODOLOGY:
- Guidelines advise against routine initiation of aspirin for primary prevention of atherosclerotic cardiovascular disease events in older adults, yet many continue to use it. The long-term effects of using aspirin in this population remain uncertain.
- Researchers analyzed data from 15,668 older adults from Australia and the US who took part in the ASPREE trial (median age at the end of the trial, 79 years; 43.1% men) to assess the post-trial and long-term effects of aspirin on cardiovascular events.
- At enrollment, the participants had no history of cardiovascular events, dementia, or any physical disability that limited their independence.
- The participants were randomly assigned to receive daily low-dose aspirin (100 mg) or a matching placebo and were followed for a median of 4.7 years during the trial.
- The occurrences of incident MACE and major hemorrhage were tracked for an additional median follow-up of 4.3 years after the trial. The combined median follow-up, including the in-trial and post-trial periods, was 8.3 years.
TAKEAWAY:
- Over the combined follow-up period, participants who received aspirin experienced no significant benefit for MACE compared with those who received placebo.
- However, during the post-trial period, the use of aspirin was linked to an 18% higher rate of MACE (hazard ratio [HR], 1.18; 95% CI, 1.02-1.37) and a 25% higher rate of myocardial infarction (HR, 1.25; 95% CI, 1.01-1.54) than the use of placebo.
- Over the combined follow-up period, users of aspirin experienced a 24% higher rate of major hemorrhage than users of placebo (HR, 1.24; 95% CI, 1.10-1.39). Aspirin users also had higher rates of upper gastrointestinal bleeding and bleeding at another site.
IN PRACTICE:
“Other research suggests that certain subgroups might benefit from aspirin for primary prevention. However, established bleeding risks and also the possible absence of long-term MACE benefit need to be considered in clinical decision-making,” the researchers reported.
SOURCE:
This study was led by Rory Wolfe, PhD, of Monash University in Melbourne, Australia. It was published online on August 12, 2025, in the European Heart Journal.
LIMITATIONS:
The researchers could only ascertain the use of aspirin at the annual visits, which prevented precise tracking of changes between visits. The post-trial comparison was not randomized, which may have influenced the assessment of risks.
DISCLOSURES:
This study received grants from the National Institute on Aging and National Cancer Institute at the National Institutes of Health in the USA, the National Health and Medical Research Council of Australia, Monash University, and the Victorian Cancer Agency. Aspirin and placebo were provided by Bayer AG. Several authors reported receiving research support or honoraria and having other financial ties with various sources, including Bayer.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.