HMN 2025: How Taking aspirin daily provides no long-term prevention of cardiovascular events in older adults

Research from a Monash University-led team has confirmed 2018 research that found healthy older adults who took a low-dose of aspirin daily experienced a higher risk of a major hemorrhage without any overall cardiovascular benefit.

The new study, published in the European Heart Journal, involved 15,668 Australian and American adults, predominantly aged 70 years or over, who previously entered the ASPREE clinical trial without any history of cardiovascular disease events, dementia, or independence-limiting physical disability, and who were then followed for more than four years post-trial in the ASPREE-eXTension study.

The original ASPREE clinical trial, published in 2018, followed participants for a median of 4.7 years during the initial trial phase from their random allocation to receive either 100mg of aspirin daily or a placebo. The new extension study continued to track the outcomes of participants after the trial ?for an additional 4.3 years, resulting in? a combined median follow-up period ?of 8.3 years.

First author Professor Rory Wolfe, a principal investigator of the ASPREE-XT study from the School of Public Health and Preventive Medicine, said that during the combined follow-up period there was no evidence overall of cardiovascular prevention with aspirin, but there was evidence of increased major hemorrhage risk in the group randomized to receive aspirin compared to those randomized to placebo.

“Surprising us, during the post-trial phase, the participants who had initially been randomized to aspirin experienced a 17% increase in major adverse cardiovascular events compared to those initially randomized to placebo,” Professor Wolfe said.

“The overall findings from the original trial suggested that the long-term use of aspirin may not only fail ?to provide cardiovascular protection in healthy older adults but also significantly increase the risk of hazardous bleeding complications. Our new results confirm those insights.

“Our findings suggest that individuals taking aspirin for possible primary prevention of cardiovascular events should discuss with their doctors possibly stopping the drug, noting that this advice would not apply to anyone taking aspirin who had already experienced a cardiovascular event and was taking it to prevent recurrent events.”

Co-author Dr. Andrew Tonkin, from the School of Public Health and Preventive Medicine, said that certain individuals might still benefit from taking aspirin for primary cardiovascular prevention, but should carefully consider the risks and benefits in consultation with their GP.

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