The net benefit of ongoing aspirin treatment for the secondary prevention of cardiovascular events is now well-established but the role that this antiplatelet agent should play in the primary prevention of cardiovascular disease remains subject to clarification, a matter that has recently been addressed in a large comparative study recently published in the New England Journal of Medicine. Participants were randomly assigned to receive 100 mg of enteric-coated aspirin or placebo, and were assessed against a primary composite end-point including all-cause mortality, dementia, or persistent physical disability. Secondary end points included major hemorrhage and cardiovascular disease (defined as fatal coronary heart disease, nonfatal myocardial infarction, fatal or nonfatal stroke, or hospitalization for heart failure). 9525 people received aspirin and 9589 got placebo. After a median of 4.7 years of follow-up, the rate of cardiovascular disease was not significantly different, but major hemorrhage was more common amongst those who received aspirin (hazard ratio, 1.38; 95% CI, 1.18 to 1.62; P<0.001). Low-dose aspirin as a primary prevention strategy in older adults resulted in a significantly higher risk of major hemorrhage and did not result in a significantly lower risk of cardiovascular disease than placebo.

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