Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial

Wolfe, R; Broder, JC; Zhou, Z; Murray, AM; Ryan, J; Chan, AT; Nelson, MR; Woods, RL; Ernst, ME; Orchard, SG; Kirpach, B; Reid, CM; Shah, RC; Stocks, N; Margolis, KL; Neumann, JT; Wilson, M; Fitzgerald, S; Mahady, SE; Wood, EM; Ket, S; Eaton, CB; Hand, P; Malik, M; Abhayaratna, WP; Venkataraman, P; Chan, P; Cloud, GC; Donnan, GA; Williamson, JD; Tonkin, AM

doi:10.1093/eurheartj/ehaf514

Prevention & lipids

Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial

Eur Heart JPublished 12 Aug 2025Extended follow-up of the ASPREE randomised trial

Primary result · MACE, entire in-trial and post-trial periodResultHazard ratio 1.04 95% CI .94, 1.15

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Authors' conclusion

The present study provides novel evidence concerning long-term MACE and haemorrhage following aspirin use in initially healthy older adults.

Study context

Population: Adults aged ≥70 years (≥65 years for US minorities) without prior CV events, dementia or independence-limiting physical disability15,668 in post-trial follow-up
Participants: 19,114 adults

Comparison: Low-dose aspirin vs placebo
Aspirinn = 9,525
Placebon = 9,589reference
Primary endpoint: Major adverse cardiovascular events (MACE) and major haemorrhage (long-term and post-trial effects)
Follow-up: Entire in-trial (2010-17) and post-trial (2017-22) period

Methodological detailsplacebo-controlled, in-trial and post-trial follow-up

Placebo-controlled
In-trial and post-trial follow-up

Primary result

MACE, entire in-trial and post-trial period

Hazard ratio

1.04

95% CI .94, 1.15

Aspirinvs Placebo

HR 1.04 (95% CI .94, 1.15)

As reported in the abstract

Further findings

Outcome	← Lower risk with aspirin ←→ Higher risk with aspirin →	HR (95% CI)
MACE, post-trial period · median 4.3 yearsHigher rate with aspirin	0.512	1.17 (1.01–1.36)
	0.512Hazard ratio (log scale)

Safety

Outcome	← Lower risk with aspirin ←→ Higher risk with aspirin →	HR (95% CI)
Major haemorrhage, entire periodHigher rate with aspirin	0.512	1.24 (1.10–1.39)
	0.512Hazard ratio (log scale)

Original publication

Aspirin, cardiovascular events, and major bleeding in older adults: extended follow-up of the ASPREE trial. Eur Heart J. Published 12 August 2025. doi:10.1093/eurheartj/ehaf514

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