Does aspirin prophylaxis improve health in older adults?

Every day, family physicians are confronted with the clinical question of whether or not to start a patient on aspirin for the primary prevention of cardiovascular disease. The editorials in the June 15th issue of AFP by Dr. W. Fred Miser ("Appropriate Aspirin Use") and Drs. Bailey, Smyth, and Campbell ("The Case Against Routine Aspirin Use") highlight the current difficulties in putting the 2009 U.S. Preventive Services Task Force recommendations on aspirin prophylaxis into practice. There is limited information available to inform benefit versus risk decisions regarding aspirin prophylaxis in healthy older adults. Given the significant projected growth of the elderly population, especially of older minorities, family physicians will need to address aspirin prophylaxis decisions more frequently in the future.

To address areas of uncertainty beyond the 2009 USPSTF guidelines, the ASPirin in Reducing Events in the Elderly (ASPREE) clinical trial aims to answer a simple question with significant public health relevance: Does daily low-dose aspirin use maintain longevity without cognitive and functional disability in healthy men and women age 70 years or older? Currently, recruitment of 19,000 older adults who do not require aspirin for a cardiovascular condition is ongoing at over 20 sites in the U.S. in addition to general practices in Australia. In the U.S., results from ASPREE should hopefully provide insight on how aspirin works in all older persons, including members of minority groups. In order to succeed, ASPREE will require the engagement of family physicians and other primary care clinicians. Family physicians can make a significant contribution by identifying healthy, older persons from minority communities and providing them with information about how to participate in the study. More information about the study and locations of study sites in the United States can be found at www.ASPREE.org.

Raj C. Shah, MD
Rush University Medical Center
Chicago, Illinois
Raj_C_Shah@rush.edu

Disclosure: The author is a co-investigator on the ASPREE study.