Should Older Patients Take Aspirin for Primary Prevention?

There was a time when enthusiasm existed for aspirin for primary prevention of cardiovascular disease and stroke, with the 1989 Physicians' Health Study showing a benefit, even at the cost of some hemorrhagic strokes (N Engl J Med 1989; 321:129). But the preponderance of data over time has chilled that enthusiasm. The randomized, placebo-controlled Aspirin in Reducing Events in the Elderly (ASPREE) study contributed greatly to this evidence for people aged 70 and older (NEJM JW Gen Med Oct 15 2018 and N Engl J Med 2018; 379:1499, 1509, 1519). In the 19,114 participants without cardiovascular disease, dementia, or disability, aspirin (100 mg daily) was associated with higher all-cause mortality, no reductions in cardiovascular disease, and g…