Key result
Aspirin 50 mg links to similar MACE but lower bleeding risk than 100 mg.
Why the study?
Low-dose aspirin is associated with increased bleeding, and evidence has not been established for a lower dose of aspirin for primary and secondary cardiovascular disease prevention.
Does aspirin 50 mg/day reduce bleeding and gastrointestinal adverse events while maintaining cardiovascular benefits compared to aspirin 100 mg/day in older adults for primary and secondary CVD prevention?
Cohort (n=7,021)
Yes
Does aspirin 50 mg/day reduce bleeding and gastrointestinal adverse events while maintaining cardiovascular benefits compared to aspirin 100 mg/day in older adults for primary and secondary CVD prevention?
Hazard Ratio: 0.861 (95% CI 0.506–1.464)
Absolute Event Rate: 2.71% vs 2.31%
p-value: p=0.577
In older Chinese adults, aspirin 50 mg/day provides similar cardiovascular protection to 100 mg/day but with significantly lower risks of bleeding and gastrointestinal adverse events.
Should not yet change practice; leaves open randomized evaluation of 50-mg aspirin in older adults.
Introduction Although low-dose aspirin effectively reduces atherothrombosis occurrence in individuals diagnosed with cardiovascular disease (CVD) or in those with high-risk factors, it is significantly associated with increased bleeding. No evidence has been established for a lower dose of aspirin. Methods The Lower-dose Aspirin for Primary and Secondary Prevention of Cardiovascular Disease in the Elderly (LAPIS) is a multicenter, prospective, observational cohort study, which compared the benefits and risks in adults aged 60 years and older taking aspirin 50 or 100 mg/day for primary and secondary CVD prevention in a propensity score-matched population. The efficacy outcome was a composite of the first occurrence of major adverse cardiovascular events (MACE). The safety outcome was the first occurrence of any hemorrhagic events. Results In this interim analysis of LAPIS, 7,021 participants were followed up for a median of 183 (95% CI 169–197) days (primary prevention cohort, 2,070; secondary prevention cohort, 4,951). After adjusting for baseline characteristics using propensity score matching, the MACE incidence did not differ significantly between the two dosage groups in either cohort. However, in the primary prevention cohort, the incidence of any bleeding [8.89 vs. 3.45 events/100 patient-years, hazard ratio (HR) 2.917, 95% confidence interval (CI) 1.719–4.952, P < 0.001] and gastrointestinal events (8.30 vs. 5.04 events/100 patient-years, HR 1.745, 95% CI 1.047–2.907, P = 0.037) was higher in the 100 mg/day group. In the secondary prevention cohort, the 100 mg/day group showed higher rates of any bleeding (9.19 vs. 6.37 events/100 patient-years, HR 1.473, 95% CI 1.087–1.998, P = 0.015), minor bleeding (9.10 vs. 6.06 events/100 patient-years, HR 1.541, 95% CI 1.116–2.127, P = 0.009), and gastrointestinal adverse events (7.10 vs. 3.53 events/100 patient-years, HR 1.943, 95% CI 1.291–2.925, P = 0.002). Conclusion Aspirin 50 mg/day was associated with lower hemorrhage and gastrointestinal adverse event risks, with similar cardiovascular benefits, compared with aspirin 100 mg/day, and may be preferred to balance efficacy and safety for older Chinese adults in primary and secondary CVD prevention.
No takes yet. Share an insight, caveat, or question.
Wang et al. (2026) conducted a cohort in Cardiovascular disease (primary and secondary prevention) (n=7,021). Aspirin vs. Aspirin 100 mg/day was evaluated on Major adverse cardiovascular events (MACE) in secondary prevention cohort (HR 0.861, 95% CI 0.506-1.464, p=0.577). In older Chinese adults, aspirin 50 mg/day was associated with similar cardiovascular benefits but significantly lower risks of bleeding and gastrointestinal adverse events compared to aspirin 100 mg/day.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: