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Primary prevention aspirin among the elderly: challenges in translating trial evidence to the clinic

J William McEvoy1, Michael Keane2, Justin Ng3

  • 1Professor of Preventive Cardiology National University of Ireland and National Institute for Prevention and Cardiovascular Health, Moyola Lane, Newcastle, Galway, H91 FF68, Ireland.

The British Journal of Cardiology
|June 24, 2022
PubMed

Insights

Daily low-dose aspirin (LDA) did not prevent disability or cardiovascular disease (CVD) in healthy older adults over 70. However, LDA significantly increased hemorrhage risk, impacting clinical practice guidelines for elderly care.

Area of Science:

  • Gerontology
  • Cardiovascular Medicine
  • Pharmacology

Background:

  • The ASPirin in Reducing Events in the Elderly (ASPREE) trial investigated primary cardiovascular disease (CVD) prevention in healthy older adults.
  • Previous understanding suggested potential benefits of low-dose aspirin (LDA) for primary CVD prevention in the elderly.

Purpose of the Study:

  • To analyze the nuances of the ASPREE trial findings.
  • To discuss the implications of ASPREE results for individual clinical care of older adults.

Main Methods:

  • The ASPREE trial compared daily low-dose aspirin (LDA) with placebo in healthy individuals aged 70 years and older.
  • Primary outcomes included prevention of disability and major adverse cardiovascular events (MACE).
  • Secondary outcomes assessed bleeding events, particularly hemorrhage.

Main Results:

  • Daily LDA did not statistically significantly reduce the risk of disability or CVD in the elderly population studied.
  • LDA use was associated with a significant increase in the risk of major hemorrhage compared to placebo.
  • These findings have led to immediate revisions in clinical practice guidelines.

Conclusions:

  • For healthy adults aged 70+, daily LDA does not offer statistically significant primary prevention benefits for disability or CVD.
  • The increased risk of hemorrhage outweighs potential benefits in this demographic.
  • Careful consideration of ASPREE trial nuances is crucial for applying findings to individual patient care.

Keywords:
aspirincardiovascular diseaseelderly patientsprimary prevention

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