# Should healthy older adults take aspirin for primary cardiovascular prevention?

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**Summary:** No — in healthy adults aged 70 and over, aspirin did not reduce cardiovascular events and increased major bleeding.

ASPREE randomised 19,114 community-dwelling adults aged 70 and over (65 and over for US minority groups) without cardiovascular disease, dementia, or disability to low-dose aspirin or placebo. Aspirin did not significantly reduce cardiovascular events, while major haemorrhage occurred significantly more often on aspirin [1].

In the same trial, all-cause mortality was higher in the aspirin group than in the placebo group, a finding driven largely by cancer-related deaths, which was unexpected and remains incompletely explained [2]. Taken together, the two reports gave no support for routine primary-prevention aspirin in this age group.

The 2022 USPSTF recommendation reflects this evidence: it advises against starting aspirin for primary prevention in adults aged 60 and over, and frames initiation between ages 40 and 59 in higher-risk individuals as a decision requiring individual judgement about bleeding risk [3]. None of this applies to secondary prevention, where aspirin retains an established role.

## Limitations

- ASPREE enrolled a healthy, largely white population without established cardiovascular disease; results do not transfer to secondary prevention or to higher-risk primary-prevention groups.
- The excess cancer mortality signal was unanticipated, was not the primary endpoint, and has not been consistently replicated.

## Sources

1. [IV / Randomised trial] Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. New England Journal of Medicine (2018). PMID 30221597. https://pubmed.ncbi.nlm.nih.gov/30221597/
2. [IV / Randomised trial] Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. New England Journal of Medicine (2018). PMID 30221595. https://pubmed.ncbi.nlm.nih.gov/30221595/
3. [I / Guideline] Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA (2022). PMID 35471505. https://pubmed.ncbi.nlm.nih.gov/35471505/

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