Age-related efficacy of aspirin in secondary prevention of coronary artery disease: START-ANTIPLATELET registry and meta-analysis of randomized trials.
Emanuele Valeriani, Rossella Marcucci, Marcello Di Nisio et al.
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In 30 seconds
This study examined whether age modifies aspirin’s efficacy for secondary prevention in coronary artery disease. It combined a multicentre prospective registry of patients hospitalized with acute coronary syndrome and treated with aspirin monotherapy with a systematic review and meta-analysis of randomized trials. In the registry, patients aged ≥65 years had more major adverse cardiovascular events than younger patients, with an absolute increase of 5 events per 1,000 patient-months. Across 19 trials involving 58,394 participants, older aspirin-treated adults also had higher event risk than younger adults (RR 1.41, 95%CI 1.14–1.73).
Key findings
- In the registry, age ≥65 years was associated with an absolute increase of 5 major adverse cardiovascular events per 1,000 patient-months.
- The registry reported an adjusted hazard ratio of 3.94 (95%CI 0.84–18.65) for major adverse cardiovascular events in older patients.
- Across 19 trials and 58,394 participants, older adults receiving aspirin had higher major adverse cardiovascular event risk than younger adults (RR 1.41, 95%CI 1.14–1.73).
Why it matters
The findings suggest that age may be relevant when assessing residual cardiovascular risk during aspirin monotherapy for secondary prevention. They highlight a potential difference in outcomes from age 65 onward, while not establishing that aspirin should be withheld or replaced. The results may inform interpretation of risk and the need for further evidence on age-specific antiplatelet strategies.
What to keep in mind
The registry comparison was observational and therefore cannot establish that age caused the outcome difference. The abstract does not provide details on follow-up duration or the individual trials’ characteristics.