Should an 82-year-old patient continue taking Aspirin (Acetylsalicylic Acid) for primary prevention of cardiovascular events?

From the Guidelines

For an 82-year-old patient, the 2025 American Diabetes Association (ADA) guidelines do not generally recommend continuing aspirin (ASA) for primary prevention of cardiovascular disease due to the increased risk of bleeding outweighing potential cardiovascular benefits. The recent trials, including ASCEND, ARRIVE, and ASPREE, published in 2018, found a lack of net benefit of aspirin for primary prevention of ASCVD, with an increased risk of bleeding 1. These findings guided the updated aspirin recommendations in the 2019 ACC/AHA Guideline on the Primary Prevention of CVD, which state that most healthy people do not need to take aspirin, and there were no sex-specific recommendations 1.

Key considerations for deciding whether to continue aspirin therapy in an 82-year-old patient include:

• The patient's overall health status and presence of any bleeding risk factors, such as prior gastrointestinal bleeding, known bleeding disorder, severe liver disease, thrombocytopenia, concurrent anticoagulation or NSAID use, or uncontrolled hypertension 1
• The presence of established cardiovascular disease, which may affect the risk-benefit ratio of aspirin therapy
• The patient's personal preferences and values regarding the potential benefits and risks of aspirin therapy

Other preventive strategies should be prioritized, including:

• Optimal blood pressure control
• Statin therapy if indicated
• Smoking cessation if applicable
• Good glycemic control

Ultimately, the decision to continue aspirin therapy in an 82-year-old patient should be individualized based on a shared decision-making approach, taking into account the patient's unique characteristics, health status, and preferences 1.

From the Research

Aspirin Therapy for Primary Prevention in an 82-Year-Old

• The use of aspirin for primary prevention of cardiovascular disease in older adults is a topic of ongoing debate 2, 3, 4, 5.
• Studies suggest that the benefit-to-risk ratio of aspirin use in primary prevention is unclear, with the reduction in thromboembolic events being counterbalanced by an increased risk of bleeding 2, 3.
• The decision to continue aspirin therapy for primary prevention in an 82-year-old should be based on an individualized assessment of both benefits and harm, taking into account the patient's cardiovascular risk factors, bleeding risk, and personal preferences 2, 5.
• According to some studies, aspirin should only be given for primary prevention in older adults after a comprehensive evaluation of an individual patient's thrombotic and haemorrhagic risk has been conducted 4, 5.
• The American Diabetes Association (ADA) 2025 guidelines do not provide specific recommendations on the use of aspirin for primary prevention in older adults, but emphasize the importance of individualized decision-making and consideration of cardiovascular risk factors 2, 5.

Considerations for Aspirin Therapy in Older Adults

• Older adults are at higher risk for bleeding complications from aspirin therapy, which must be weighed against the potential benefits of reducing cardiovascular events 3, 4, 5.
• The use of aspirin in primary prevention may be more beneficial in older adults who are at high risk of cardiovascular events, but the decision should be made on a case-by-case basis 2, 5.
• Clinicians should consider the patient's overall health status, comorbidities, and medication regimen when deciding whether to continue or initiate aspirin therapy for primary prevention 6, 5.