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General medicine
Aspirin for the primary prevention of cardiovascular disease in the elderly
  1. Jack W O’Sullivan1,2,3
  1. 1 Division of Cardiology, Department of Medicine, Stanford University, Stanford, California, USA
  2. 2 Centre for Evidence-Based Medicine, University of Oxford, Oxford, Oxfordshire, UK
  3. 3 , Stanford University, Stanford, California, USA
  1. Correspondence to Dr Jack W O’Sullivan, Division of Cardiology, Department of Medicine, Stanford University, Stanford, CA 94303, USA; jackos{at}

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The tension between the benefits and harms of anticoagulation is finely balanced. Prophylactic aspirin in healthy, elderly patients provides no benefit and causes harm; clinicians should not use it for primary prevention in otherwise well patients aged over 70.

As the world’s population ages, health in later life has become a public health priority. The prevention of disease is critical to these aims. As a chief cause of morbidity in the elderly,1 the prevention of cardiovascular disease is of particular focus. 

The use of aspirin unequivocally benefits patients who have already suffered a cardiovascular event.2 3 However, its role in primary prevention is much more contentious.4–6 The Aspirin in Reducing Events in the Elderly (ASPREE) trial7 set out to address the uncertainty surrounding the prophylactic use of aspirin in healthy, elderly patients.

The ASPREE investigators randomised almost 20 000 people to receive 100 mg aspirin or placebo. Included participants were 70 years or older …

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