Aspirin for all over 50 revisited

The idea that low-dose aspirin could be recommended for vascular protection on the grounds of age alone, irrespective of the levels of other vascular risk factors, seems to have been first suggested by the editor of the Archives of Internal Medicine, who, in 1991 wrote: “In my opinion, aspirin therapy is indicated in US men aged 50 years or older and in women after the menopause”.1 Later, a group of British organisations recommended cardioprotection by daily aspirin for subjects aged over 50 years “whose hypertension, if present, is controlled”.2 The US Preventive Services Task Force stated that “men older than 40 years [and] postmenopausal women… may wish to consider aspirin therapy”.3 Most recently, a report from Wales,4 based on the individual risk factor data for subjects in a large population cohort, together with data for a cohort of women, gave evidence suggesting that aspirin prophylaxis is reasonable from about 42 years of age on average for men, and for 80% of men from about age 49 years, while in women the average age at which aspirin prophylaxis becomes reasonable was judged to be about 53 years. A report, published as a companion paper to this last, vigorously opposed the idea of aspirin prophylaxis on the grounds of age alone.5 this issue of the journal Bulugahapitiya et al present evidence based on the levels of vascular risk factor levels of 12 000 patients without diabetes, aged between 30 and 74 years, drawn at random from the practice lists of 304 primary care practices throughout the UK (see page 1429).6 The authors estimate that the age at which vascular risk reaches the level at which aspirin prophylaxis should be considered (10% within 10 years) is 48 years for men, and 57 years …