Older age (≥65 years) was associated with an increased risk of major adverse cardiovascular events in patients receiving aspirin for secondary prevention of coronary artery disease (RR 1.43; 95% CI 1.16-1.76).
Cohort (n=410)
Yes
Does the efficacy of aspirin monotherapy for secondary prevention of coronary artery disease differ between patients aged ≥65 years and <65 years?
Aspirin monotherapy for secondary prevention of coronary artery disease shows reduced efficacy in patients aged 65 years and older compared to younger patients.
Relative Risk: 1.43 (95% CI 1.16–1.76)
BACKGROUND Aspirin is a standard therapy for secondary prevention in coronary artery disease, yet its antiplatelet effect varies and incomplete thromboxane-A₂ inhibition has been shown in older individuals. Because no age threshold currently guides treatment, we investigated whether aspirin efficacy differs across predefined age cut-off in patients with coronary artery disease. METHODS We analyzed data from START-ANTIPLATELET registry, a multicenter prospective registry of patients hospitalized for acute coronary syndrome and subsequently treated with at least one month of aspirin monotherapy. Patients were stratified by age ≥65 vs <65 years. The primary endpoint was major adverse cardiovascular events, evaluated using Kaplan-Meier estimates and multivariable Cox regression. A systematic review and meta-analysis were conducted to evaluate the effect of aspirin for secondary prevention in older versus younger adults. Pooled risk ratios with 95% confidence intervals were calculated using a random-effects model. RESULTS 410 patients were included in the registry, of whom 53.7% had ≥65 years. Patients aged ≥65 years exhibited a substantially higher incidence of major adverse cardiovascular events than younger patients, for an absolute increase of 5 events per 1,000 patient-months. Older age was associated with increased risk of major adverse cardiovascular events (hazard ratio 4.99, 95%CI 1.11-22.58) independently of other cardiovascular risk factors (hazard ratio 3.94, 95%CI 0.84-18.65). The meta-analysis of 58,394 participants from 19 trials confirmed the increased risk of major adverse cardiovascular events among older individuals receiving aspirin compared with younger patients (RR 1.43, 95%CI 1.16-1.76). CONCLUSION The efficacy of aspirin monotherapy for secondary coronary artery disease prevention is reduced in elderly patients from 65 years of age onward.
Valeriani et al. (Fri,) conducted a cohort in coronary artery disease (n=410). Older age (≥65 years) vs. Younger age (<65 years) was evaluated on major adverse cardiovascular events (RR 1.43, 95% CI 1.16-1.76). Older age (≥65 years) was associated with an increased risk of major adverse cardiovascular events in patients receiving aspirin for secondary prevention of coronary artery disease (RR 1.43; 95% CI 1.16-1.76).