For decades, many people believed that taking a daily low-dose aspirin could protect the heart and prevent heart attacks or strokes.
But new research led by Monash University has confirmed that for healthy older adults, the risks may outweigh the benefits.
The findings, published in the European Heart Journal, build on earlier results from the ASPREE clinical trial, first reported in 2018.
That large international study followed more than 19,000 adults in Australia and the United States, most of them aged 70 or older, who had no history of cardiovascular disease, dementia, or major disability at the start.
Participants were randomly assigned to take either 100 milligrams of aspirin each day or a placebo, and they were tracked for nearly five years.
The original ASPREE trial showed that daily aspirin did not lower the risk of cardiovascular events such as heart attack or stroke.
Instead, it was linked to a higher risk of major bleeding, including serious stomach and brain hemorrhages.
The new research comes from the ASPREE-eXTension (ASPREE-XT) study, which followed 15,668 of the original participants for an additional 4.3 years after the trial ended. Together, the two phases provided a median of 8.3 years of follow-up, making this one of the longest studies of its kind.
According to lead author Professor Rory Wolfe, the long-term picture is clear. “We found no evidence overall that aspirin prevented cardiovascular events,” he explained.
“What we did see was an increased risk of major bleeding in those who had been randomized to aspirin compared with those given a placebo.”
Perhaps most surprising was what happened after the trial ended. During the post-trial years, participants who had originally been assigned aspirin actually experienced a 17 percent increase in major cardiovascular events compared with the placebo group.
The reasons for this finding are not yet fully understood, but it further challenges the long-standing idea that aspirin helps protect otherwise healthy older adults from heart disease.
“The overall findings suggest that the long-term use of aspirin not only fails to protect the heart in healthy older adults but can also increase the risk of dangerous bleeding complications,” Professor Wolfe said.
Co-author Dr. Andrew Tonkin emphasized that aspirin still plays a critical role for people who have already had a heart attack or stroke. In those cases, it is widely prescribed to prevent another event. But for healthy individuals taking aspirin in the hope of prevention, the risks may outweigh the rewards.
Experts stress that people should not stop taking aspirin on their own but should consult their doctor to weigh personal risks and benefits.
The study highlights the importance of tailoring medical advice to each individual, rather than relying on one-size-fits-all assumptions.
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