Aspirin is not routinely recommended for use in primary prevention of cardiovascular disease (CVD) in Australian guidelines1 or internationally. However, it has been used in the past for primary prevention of CVD, partly due to the extrapolation of its well-established benefits in secondary prevention of CVD.2,3

Learning objectives

After reading this article, pharmacists should be able to:

  • Describe why aspirin has previously been used in primary prevention of cardiovascular disease
  • Discuss the findings of the ASPREE study in relation to aspirin use in healthy elderly people
  • Identify the adverse effects of prolonged use of low-dose aspirin commonly seen in elderly people.

Competency (2016) standards addressed: 1.1, 3.1, 3.2, 3.5.

Accreditation number: CAP1903D

Tradition also has a significant role to play in aspirin’s popularity for primary prevention, as older studies indicated a benefit of aspirin in primary prevention of CVD.4 However, more recent meta-analyses have concluded that the risk of bleeding outweighs the benefit for aspirin in primary prevention of CVD.5,6 Study cohorts included patients with diabetes.6 Prior to the publication of the long-awaited Aspirin in Reducing Events in the Elderly (ASPREE) trial, there was no study specifically focusing on the role of aspirin in primary prevention for older persons (70 years or older).

Apart from the impact of aspirin on CVD, there have been some trends suggesting aspirin may reduce the incidence of cancer and cancer-related mortality. The ASPREE study also sought to elucidate this.

What was the ASPREE study?

The aim of the ASPREE study was to investigate whether daily use of 100 mg of enteric-coated aspirin would prolong the healthy life span of older adults. Outcomes investigated included death from any cause, cancer-related death,7 major bleeding, cardiovascular disease,8 dementia, and persistent physical disability.9

Test your knowledge on this article’s assessment questions here to earn up to 1.5 Group 2 CPD credits.