Low-dose aspirin and incident atrial fibrillation in healthy older individuals: a post-hoc analysis of the ASPREE trial

The incidence and prevalence of atrial fibrillation (AF) are increasing in parallel with global ageing and increase in patients with cardiovascular risk factors such as hypertension, obesity, and diabetes. Although the physiological mechanisms responsible for the development of AF are multifactorial, inflammation (including continuous low-grade inflammation associated with ageing), vascular pathology, and cardiac structural and electrical remodelling are key contributors.1 New strategies for the primary prevention of AF such as targeting inflammatory and vascular pathways are required to slow down the rapid increase in global prevalence and the burden of associated disability-adjusted life years.1 Aspirin could be considered for primary AF prevention given its anti-inflammatory and vascular protection properties in addition to its antithrombotic activity.2 However, investigators have not tested whether low-dose aspirin is effective for primary AF prevention in an older population where AF is the most prevalent. Only one previous observational study investigated the association between aspirin use and incident AF.3 In the Physicians’ Health Study cohort of 23 480 male participants, 2820 cases of AF during the 10 year follow-up were reported, but no association between aspirin use and incident AF was identified.3