In 2018, the findings from the ASPREE trial of low dose aspirin changed clinical guidelines around the world when it reported that there was no overall benefit of taking daily low dose aspirin for 4.7 years in older adults who were initially healthy and free of cardiovascular disease – that is, no benefit of low dose aspirin for ‘primary prevention’ in older adults.
Thanks to the ongoing involvement of the ASPREE trial participants who agreed to continue to have their health tracked as part of a follow up cohort study – ASPREE-XT – it has been possible to understand the longer-term consequences of aspirin use in this group of over 15,000 older adults.
A recent publication led by Professor Rory Wolfe in the European Heart Journal, the cardiovascular health of ASPREE participants was examined post-trial for a further 4 years. It found that over the longer follow-up there was no ‘legacy’ benefit of aspirin for cardiovascular disease, with the trend towards a reduction in major cardiovascular events seen with aspirin during the trial phase reversed in the post-trial follow up.
And for those who reached the end of the ASPREE trial phase free of heart disease but made the choice to continue taking aspirin after the trial, there was no cardiovascular benefit from longer-term aspirin use.
Aspirin is known to increase risk of bleeding – this effect was seen during the in-trial phase of ASPREE with a 38% increase in risk of major bleeding. In the post-trial phase (once participants had stopped taking study medication) there was no difference in risk of major bleeding between those who had been allocated aspirin versus those who had been allocated placebo.
ASPREE’s ongoing research is exploring the wide range of health impacts that aspirin may have, and whether there are certain groups in whom the effects of aspirin may differ. Prof Wolfe said “If you are an older adult who doesn’t have heart disease and you are choosing to take aspirin for prevention, you should discuss this with your doctor – new evidence continues to emerge enables us all to make more informed health decisions“.
You can listen to Professor Rory Wolfe, Principal Investigator of the ASPREE-XT study, talk to Norman Swan about these findings on ABC Radio National’s Health Report here.