Effect of aspirin on healthspan in community-dwelling older adults: the ASPirin in reducing events in the elderly study
Daily low-dose aspirin did not delay major disease or death in healthy older adults.
*Randomized placebo-controlled trial secondary analysis; Level 2 (OCEBM).
Citation
Zheng HT, Phyo AZZ, Wu Z, et al. Effect of aspirin on healthspan in community-dwelling older adults: the ASPirin in reducing events in the elderly study. Age and Ageing. 2026;55:afag218. doi:10.1093/ageing/afag218
Background
Inflammation contributes to many age-related diseases, so aspirin has been proposed as a possible way to extend healthy life. Prior aspirin studies in older adults showed mixed effects on heart disease, cancer, dementia, diabetes, and death.
Patients
19,114 community-dwelling adults aged 70 years or older, or 65 years or older for United States minority ethnic groups. Participants were initially free of dementia, cardiovascular disease, major physical disability, and conditions likely to cause death within 5 years.
Intervention
100 mg enteric-coated aspirin daily.
Control
Matching placebo.
Outcome
Loss of healthspan, defined as first occurrence of cardiovascular disease, diabetes, dementia, cancer, or death.
Follow-up Period
Median 4.7 years.
Results
| Outcome | Aspirin | Placebo | Finding |
|---|---|---|---|
| Loss of healthspan | 82.1 events per 1,000 person-years | 82.7 events per 1,000 person-years | NS |
Overall, 5,835 participants experienced healthspan loss. Diabetes was the most common contributor, followed by cancer, cardiovascular disease, dementia, and death. Older age, male sex, smoking, hypertension, obesity, and frailty were more common among those losing healthspan.
Analyses were intention-to-treat. Sensitivity analyses excluding baseline diabetes, adding persistent physical disability, or removing diabetes from the outcome also found no aspirin benefit. The control reflects current primary-prevention practice for many older adults, given guideline caution against routine aspirin use.
Limitations
Healthspan loss was not the original main trial outcome. Chronic lung disease was not included. Healthspan lacks a single accepted definition. Participants were relatively healthy volunteers, limiting generalizability to frailer older adults or those with established disease. Follow-up may have been too short to detect some long-term effects.
Funding
Public/government and university funding; funders had no role.
Clinical Application
Do not start low-dose aspirin solely to extend healthspan in healthy older adults; this reinforces current caution for primary prevention.
Discussion
Sign in to join the discussion.
In this double-blind randomized controlled trial, daily 100 mg aspirin did not reduce loss of healthspan versus placebo (82.1 vs 82.7 events/1000 person-years; HR 0.98, 95% CI 0.92–1.05). How valid and applicable are these results for deciding against aspirin for primary prevention in older adults? In this randomized trial, the hazard ratio for loss of healthspan with aspirin versus placebo was 0.98 with a 95% CI of 0.92–1.05. Which interpretation is most appropriate?