Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Does Aspirin Prevent CV Events in Older Adults?

N Engl J Med; ePub 2018 Sep 16; McNeil, et al

The use of low-dose aspirin as a primary prevention strategy in older adults did not result in a significantly lower risk of cardiovascular disease (CVD) compared to placebo and resulted in a significantly higher risk of major hemorrhage. This according to a new study that examined the effect of aspirin on CV events and bleeding in healthy elderly patients. From 2010 to 2014, researchers enrolled community-dwelling men and women in the US and Australia aged ≥70 years and did not have CVD, dementia, or disability. Participants were randomly assigned to receive 100 mg of enteric-coated aspirin or placebo. The primary end point was a composite of death, dementia, or persistent physical disability. Among the details:

  • 19,114 persons were enrolled in the trial; 9,525 received aspirin and 9,589 received placebo.
  • The rate of CVD was 10.7 events per 1,000 person-years in the aspirin group and 11.3 events per 1,000 person-years in the placebo group (HR, 0.95), after median follow-up of 4.7 years.
  • The rate of hemorrhage in the aspirin group was 8.6 events per 1,000 person-years and 6.2 events per 1,000 person-years in the placebo group (HR, 1.38).


McNeil JJ, Wolfe R, Woods RL, et al. Effect of aspirin on cardiovascular events and bleeding in the healthy elderly. [Published online ahead of print September 16, 2018]. N Engl J Med. doi:10.1056/NEJMoa1805819.

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