In a new study, researchers found low-dose aspirin does not prolong disability-free survival of healthy people over 70, even in those at the highest risk of heart disease.
The research was conducted by a team from Curtin University in Australia and other institutes.
More and more people reach the age of 70 without cardiovascular disease (CVD).
European guidelines on the prevention of CVD do not recommend aspirin for individuals free from CVD due to the increased risk of major bleeding.
This advice was subsequently supported by results in moderate risk patients (ARRIVE), diabetic patients (ASCEND), and in people over 70 (ASPREE) which demonstrated that modest reductions in CVD risk were outweighed by the increased bleeding hazard.
The primary finding from the ASPREE project was that in people aged 70 years or over with no known CVD, there was no effect of 100 mg of daily aspirin on death risk in healthy older people.
The team examined whether the results for the primary endpoint of disability-free survival might vary by the baseline level of CVD risk.
They found for people in the lowest third of CVD risk, there was no disability-free survival or cardiovascular benefit from aspirin. This group also had the highest likelihood of bleeding.
In contrast, those in the highest third of CVD risk had much lower CVD event rates on aspirin with similar rates of bleeding.
However, this reduction in CVD did not translate to improved disability-free survival.
This analysis suggests that the risk-benefit trade-off for aspirin use in healthy older men and women varies across levels of heart disease risk.
Better risk prediction methods are needed to identify those who could benefit from daily low-dose aspirin.
The team says based on the results of the main ASPREE trial, daily low-dose aspirin cannot be recommended in healthy people over 70—even in those at the greatest CVD risk.
Today’s analysis indicates that more refined methods are needed to pinpoint a subgroup who might gain from preventive therapy.
One author of the study is Professor Christopher Reid of Curtin University.
The study was presented at ESC Congress 2019 together with the World Congress of Cardiology.
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