Stratification by CVD risk equations does not inform the use of aspirin for primary prevention in older adults
Authors' conclusion
In older persons with no prior cardiovascular events, current CVD risk scores do not identify any subgroups with overall net clinical benefit from low dose aspirin.
Study context
- Population
- Older persons with no prior CV events
- Comparison
- Aspirin vs placebo, stratified by 10-year predicted CVD risk
- Primary endpoint
- CVD events and major haemorrhage by baseline predicted CVD risk tertile (T1 lower, T2 intermediate, T3 higher)
Methodological detailsplacebo-controlled, subgroup analysis by predicted CVD risk tertiles
- Placebo-controlled
- Subgroup analysis by predicted CVD risk tertiles
Primary result
As reported in the abstract
CVD events by predicted risk tertile
Proportional reduction in CVD risk
28%
95% CI 54–95%
FRS T3
Proportional reduction in CVD risk
25%
95% CI 57–97%
Atherosclerotic Cardiovascular Disease (ASCVD) T3
Safety
| Outcome | Increased risk of bleeding |
|---|---|
| Major haemorrhagic eventsAspirin vs Placebo · FRS T3 | 32% |
| Major haemorrhagic eventsAspirin vs Placebo · ASCVD T3 | 15% |
Major haemorrhagic events
- Rates of major haemorrhage highest in all T3 groups
- Significant increase in bleeding with aspirin vs placebo in all T1 groups and FRS and SCORE2-OP T2 groups
- CVD reduction in FRS and ASCVD T3 offset by increased bleeding
Original publication
Stratification by CVD risk equations does not inform the use of aspirin for primary prevention in older adults. Eur J Prev Cardiol. Published 6 June 2025. doi:10.
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