Professor John McNeil AM
Department of Epidemiology and Preventive Medicine, Monash University
17 September 2018

New study looks at low-dose aspirin use in healthy older adults.

Results of the Aspirin in Reducing Events in the Elderly (ASPREE) trial, published in the New England Journal of Medicine today has found that for healthy older adults, a low-dose aspirin makes no significant difference to preventing heart attack or stroke, nor does it increase life expectancy or the average time spent in good health.

Low-dose aspirin is used by millions of healthy elderly individuals across the world for ‘primary prevention,’ in the hope of warding off a first heart attack or stroke.

ASPREE is a bi-national clinical trial involving researchers and participants from both Australia and the United States. With funding from the US National Institutes of Health, the National Health and Medical Research Council (NHMRC) and Monash University, this study recruited over 19,000 older persons to determine the benefits and risks of taking a daily low dose of aspirin in healthy older adults without previous cardiovascular events.

The trial involved 16,700 Australians, 5,000 of whom were from rural and regional centres across four states. These individuals were adults over 70 years old free from significant health issues such as coronary heart disease, dementia, or a clinically significant physical disability.

Of the 19,114 persons who were enrolled in the trial, 9,525 were assigned to receive aspirin and 9,589 to receive a placebo treatment. The trial found that while there was no impact on prevention of cardiovascular events, there were potential side effects that could put the elderly at far greater risk of internal bleeding.

‘There is little point for elderly people to be taking a preventive medication unless it preserves good health and unless benefits of the medication outweigh any adverse effects. Previous studies have focused on reducing the incidence of cardiovascular events as their primary end point,’ said Professor McNeil. ‘However, in this age group, the long-term use of a preventive drug should be justified primarily by its ability to prolong life in good health.’

The ASPREE team is continuing to analyse the results of this study and has implemented plans for the continued follow-up of participants. Professor McNeil emphasised that further research needs to be done and that older adults should follow the advice from their own physicians about daily aspirin use.

‘These initial findings will help to clarify the role of aspirin in disease prevention for older adults, but much more needs to be learned. With the increasing numbers of older people in the Australian community strategies to prolong life free of disability has become an important focus of preventive health research’ said Professor McNeil.