The efficacy and safety of lower-dose aspirin for primary and secondary prevention of cardiovascular disease in the elderly: an interim analysis of a multicenter, prospective, observational study
Year: 2026
Type: article
Abstract: 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.
Authors: Xiting Wang, Hong Qi, Yuan Wu, Hongliang Cong, Pida Hao, Xiqiang Liu, Yong Liu, Zhuhua Yao, Aiping Jin, Yan Hou, Nabuqi He, Yingxin Zhao, Yanmei Sun, Xuefen Qian, Keshan Liang, Huaizhong Zhang, Lili Liu, Zhengxiang Zhang, Yingwu Liu, Peng Dou, Shudong Xia, Hongwei Li, Jiuyu Yang, Jie Hu, Zhangyong Xia, Bo Liu, Hailian Jin, Xiulian Yan, Wei Miao, Huanyu Guo, Longmei Zhao, Qingtan Zhang, Tao Tian, Xibo Sun, Jianwei He, Xiaoping Chen, Zhaohui Wang, Zhenghua Zhang, Qing Liu, Jianchun Wang, Sainan Zhu, Meilin Liu
Institutions: Peking University First Hospital, Chifeng University, Tianjin Chest Hospital, Linyi People's Hospital, Central Hospital of Zibo, Tianjin Third Central Hospital, Tianjin Fourth Central Hospital, Tianjin Fourth Hospital, Tianjin People's Hospital, Second Affiliated Hospital of Xi'an Jiaotong University, Nanjing University of Science and Technology, Capital Medical University, Beijing Anzhen Hospital, The First People’s Hospital of Lianyungang, Xuzhou Cancer Hospital, The Fourth People's Hospital of Zibo City, Zhejiang University, Jiangxi Provincial People's Hospital, Shandong First Medical University, Binzhou Medical University, Yidu Central Hospital of Weifang, Taiyuan Central Hospital, Wuhan Union Hospital, Huazhong University of Science and Technology, People’s Hospital of Rizhao, Shandong Provincial Hospital
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
Award: G7871671366
OpenAlex ID: W7122786686