Stratification by CVD risk equations does not inform the use of aspirin for primary prevention in older adults

Enayet K Chowdhury; Michael E Ernst; Mark R Nelson; Lawrence J Beilin; Johannes T Neumann; Andrew Tonkin; Robyn L Woods; Nigel Stocks; Paul Lacaze; Suzanne G Orchard; Zhen Zhou; Brenda Kirpach; Anne M Murray; Raj C Shah; Walter Abhayaratna; Joanne Ryan; John J McNeil; Rory Wolfe; Christopher M Reid

doi:10.1093/eurjpc/zwaf329

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Stratification by CVD risk equations does not inform the use of aspirin for primary prevention in older adults

Journal article

Peer reviewed

Stratification by CVD risk equations does not inform the use of aspirin for primary prevention in older adults

Enayet K Chowdhury, Michael E Ernst, Mark R Nelson, Lawrence J Beilin, Johannes T Neumann, Andrew Tonkin, Robyn L Woods, Nigel Stocks, Paul Lacaze, Suzanne G Orchard, …

European journal of preventive cardiology

06/06/2025

DOI: 10.1093/eurjpc/zwaf329

PMID: 40478248

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Abstract

We aimed to determine whether commonly recommended CVD risk equations would inform a risk-benefit discussion on the role for aspirin as a primary prevention strategy for CVD in older persons. We assessed aspirin's effect on CVD and major haemorrhage on the basis of baseline levels of CVD risk using risk scores pertaining to the older age groups. We used a) the Framingham (FRS), b) the Atherosclerotic Cardiovascular Disease (ASCVD), and c) the European SCORE2-OP equations to calculate 10-year predicted CVD risk. Participants were classified into predicted risk tertiles (T): lower (T1), intermediate (T2) and higher (T3) risk. We identified CVD and major haemorrhagic events utilising each risk equation's definition of CVD. The CVD event rate increased from T1 to T3 using all risk equations. For participants with greatest CVD risk (T3) according to FRS and ASCVD, aspirin versus placebo was associated with a proportional 28% (95% CI: 54 to 95%) and 25% (95% CI: 57 to 97%) reduction in CVD risk respectively. However, there was no significant effect of aspirin for individuals with low (T1) or moderate (T2) risk, nor according to the SCORE2-OP tertiles.Rates of major haemorrhagic events were highest in all T3 groups. Aspirin was associated with a significant increase in bleeding events versus placebo in all T1 groups and FRS and SCORE2-OP T2 groups. The reduction in CVD events in FRS and ASCVD T3 groups was offset by a 32% and 15% increased risk of bleeding respectively. 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.

cardiovascular disease risk prediction

cardiovascular events

aspirin

bleeding events

risk-benefit

Details

Title: Subtitle: Stratification by CVD risk equations does not inform the use of aspirin for primary prevention in older adults
Creators: Enayet K Chowdhury - Curtin University
Michael E Ernst - Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
Mark R Nelson - University of Tasmania
Lawrence J Beilin - Medical School, Royal Perth Hopital. University of Western Australia, Perth, Western Australia
Johannes T Neumann - University Medical Center Hamburg-Eppendorf
Andrew Tonkin - Monash University
Robyn L Woods - Monash University
Nigel Stocks - University of Adelaide
Paul Lacaze - Monash University
Suzanne G Orchard - Monash University
Zhen Zhou - Monash University
Brenda Kirpach - Berman Center for Outcomes and Clinical Research
Anne M Murray - Berman Center for Outcomes and Clinical Research
Raj C Shah - Rush University Medical Center
Walter Abhayaratna - University of Canberra
Joanne Ryan - Monash University
John J McNeil - Monash University
Rory Wolfe - Monash University
Christopher M Reid - Curtin University
Resource Type: Journal article
Publication Details: European journal of preventive cardiology
Publisher: OXFORD UNIV PRESS
DOI: 10.1093/eurjpc/zwaf329
PMID: 40478248
ISSN: 2047-4881
eISSN: 2047-4881
Grant note: National Institute on Aging and the National Cancer Institute at the National Institutes of Health: U01AG029824 National Health and Medical Research Council: 334047, 1127060 Monash UniversityVictorian Cancer Agency
We acknowledge the trial staff in Australia and the United States; the participants who volunteered for this trial; and the general practitioners and staff of the medical clinics who cared for the participants. The ASPREE trial was supported by a grant (U01AG029824) from the National Institute on Aging and the National Cancer Institute at the National Institutes of Health, by grants (334047 and 1127060) from the National Health and Medical Research Council, and by Monash University and the Victorian Cancer Agency.
Language: English
Electronic publication date: 06/06/2025
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science
Record Identifier: 9984827328702771

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