The benefits of low-dose aspirin as primary prevention for coronary heart disease in healthy people age 70 years or older are offset by increases in bleeding-related adverse effects, according to an article published online May 21st by the British Medical Journal.

In the epidemiological model, Australian researchers simulated the broad implications of routine use of aspirin in a population of 20,000 men and women aged 70-74 years who had no evidence of cardiovascular disease.

Major outcome measures were first myocardial infarction or episode of unstable angina, ischemic or hemorrhagic stroke, and major gastrointestinal hemorrhage. The gain in prevented cardiovascular events was offset by extra hemorrhagic events, with more involving the gastrointestinal tract than brain.

When data were modeled to show health-adjusted years, a measure that covers both length and quality of life, results were more equivocal regarding net benefit of aspirin.

These findings reinforce the need for a clinical trial to establish the true benefit or harm of aspirin in elderly people, and underscore the importance of targeting preventive treatment to those who are likely to benefit most, the authors concluded.