Aspirin not beneficial in primary prevention of CVD for those over 70

A seven-year international study has found aspirin is not beneficial in the primary prevention of cardiovascular disease for those aged over 70.

The ASPREE (ASPirin in Reducing Events in the Elderly) trial found that daily low-dose aspirin (100mg) did not prolong life free of disability, or significantly reduce the risk of a first heart attack or stroke among participants, with little difference between the placebo and aspirin groups.

The randomised, double-blind, placebo-controlled study assessed aspirin for prevention of cardiovascular disease, dementia, depression and some cancers in more than 19,114 participants in Australia and the United States. The 16,703 Australian participants were recruited through general practice with the participant’s usual treating GP as co-investigator.

According to principal investigator Professor John McNeil, head of Monash University’s Department of Epidemiology and Preventive Medicine, the results of the trial will result in a rethinking of global guidelines relating to the use of aspirin to prevent common conditions associated with aging.

‘Despite the fact that aspirin has been around for more than 100 years, we have not known whether healthy older people should take it as a preventive measure to keep them healthy for longer,’ he said.

‘Aspirin is the most widely used of all preventive drugs and an answer to this question is long overdue. ASPREE has provided this answer.

‘These findings will help inform prescribing doctors who have long been uncertain about whether to recommend aspirin to healthy patients who do not have a clear medical reason for doing so.’

The research produced results along three objectives:

The primary objective was to determine whether low-dose aspirin prolongs life, or life free of dementia, or life free of significant, persistent physical disability, in the healthy elderly.

The secondary objective related to the effects of low-dose aspirin on the key outcome areas of death, cardiovascular disease, dementia and cognitive decline, depression cancer, physical disability and major bleeding episodes.

In addition, a third objective was to examine measures included in the primary and secondary objectives. These included haemoglobin levels, urine albumin:creatinine ratios, cognitive and physical function, and hospitalisations.

’These results of the ASPREE trial indicate that, over a median follow-up of 4.7 years, the use of low-dose aspirin in persons 70 years of age or older who did not have cardiovascular disease did not prolong disability-free survival in a predominantly white population,’ the researchers wrote.

ASPREE also showed a higher rate of serious bleeding among the aspirin takers (3.8%) compared to the placebo group (2.8%).

‘It means millions of healthy older people around the world who are taking low-dose aspirin without a medical reason, may be doing so unnecessarily, because the study showed no overall benefit to offset the risk of bleeding,’ they wrote.

Professor McNeil said all patients should follow the advice of their doctor about their daily use of aspirin. He cautioned that the results do not apply to those with existing conditions such as a previous heart attack, angina or stroke, where aspirin is recommended as a valuable preventive drug.

The researchers are continuing to follow the health of the participants to determine whether beneficial effects of aspirin, such as cancer prevention, emerge sometime after taking the drug.