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Aspirin for Primary Prevention of Cardiovascular Events in the Elderly

Current Status and Future Directions

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Abstract

The role of aspirin in the secondary prevention of occlusive cardiovascular events has now been well established. Given this, aspirin in primary prevention has been the focus of several large trials and subsequent meta-analyses over the past 3 decades, and yet the issue remains controversial. Recent studies in populations with high baseline risk — such as diabetics and those with asymptomatic peripheral arterial disease — have not found the expected benefits of aspirin on cardiovascular endpoints, which contrasts with earlier studies that reported a reduced relative risk for outcomes such as myocardial infarction and ischaemic stroke, but not for mortality. Furthermore, in healthy populations, the absolute risk reduction conferred by aspirin is small and needs to be balanced against the risk of a major haemorrhage. Older adults have a higher risk for cardiovascular events and therefore might represent the group in which aspirin for primary prevention could deliver the greatest absolute benefit, yet at the same time, the elderly bear an increased vulnerability to major haemorrhage, including haemorrhagic stroke. It is also not known whether older adults experience the same risk reduction from aspirin as middle-aged individuals. The current evidence base does not sufficiently clarify whether aspirin for primary prevention confers a meaningful net benefit in the elderly.

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Acknowledgements

Professor John McNeil is a Principal Investigator for the ASPREE study, funded by the NIH and NH & MRC. Dr Stephanie A. Ward is a geriatrician working with the ASPREE study. The authors have no conflicts of interest that are directly relevant to the content of this article. No sources of funding were used to assist in the preparation of this article.

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Authors and Affiliations

  1. The Kingston Centre, Monash Ageing Research Centre (MONARC), Warrigal Road, Cheltenham, Victoria, 3192, Australia

    Stephanie A. Ward & Barbara Workman

  2. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

    Stephanie A. Ward, Lisa Demos & John J. McNeil

  3. Western Health, Sunshine, VIC, Australia

    Stephanie A. Ward

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  1. Stephanie A. Ward
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Correspondence to Stephanie A. Ward.

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Ward, S.A., Demos, L., Workman, B. et al. Aspirin for Primary Prevention of Cardiovascular Events in the Elderly. Drugs Aging 29, 251–258 (2012). https://doi.org/10.2165/11599030-000000000-00000

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