ESC 2019 — No aspirin for healthy people over age 70


  • Emily Willingham, PhD
  • Conference Reports
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Takeaway

  • Even in healthy people over age 70 with the highest risk for cardiovascular disease (CVD), low-dose aspirin is a no-go.

Why this matters

  • An earlier analysis showed an unexpected higher all-cause mortality among healthy older adults, which was tied to cancer-related deaths.
  • With an “ever-increasing number” of people reaching age 70 years without overt CVD, said study author Christopher Reid of Curtin University in Perth, Australia, better methods are needed to determine who might benefit from aspirin.
  • European guidelines already do not recommend aspirin for CVD prevention, but whether these outcomes vary by CVD risk and age has not been established.  

Results

  • People in the lowest CVD risk group experienced no survival or disability-free benefit from aspirin, but had the highest bleeding risk (HR, 2.60; P=.01 or P<.001 depending on risk score used>
  • Highest CVD risk group had lower CVD event rates:
    • Per Framingham: 0.72 (95% CI, 0.54-0.95).
    • Per atherosclerotic CVD calculation: 0.75 (95% CI, 0.58-0.97).
  • Bleeding risk was lower in this group, but they did not experience better disability-free survival.

Study design

  • Non-prespecified post hoc analysis of ASPREE.
  • Primary endpoint in this analysis was disability-free duration. 

Limitations

  • No risk equations apply for people over age 80.

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