The American journal of medicine · 2026
Age-related efficacy of aspirin in secondary prevention of coronary artery disease: START-ANTIPLATELET registry and meta-analysis of randomized trials.
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Valeriani Emanuele, Marcucci Rossella, Di Nisio Marcello, Calabrò Paolo, Cirillo Plinio, Gresele Paolo, Patti Giuseppe, Pengo Vittorio, Palumbo Ilaria Maria, Poli Daniela, Antonucci Emilia, Santilli Francesca, Pannunzio Arianna, Pignatelli Pasquale, Violi Francesco
Аннотация
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 versus < 65 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 1.41, 95%CI 1.141.73).
CONCLUSION: The efficacy of aspirin monotherapy for secondary coronary artery disease prevention is reduced in elderly patients from 65 years of age onward.
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 versus < 65 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 1.41, 95%CI 1.141.73).
CONCLUSION: The efficacy of aspirin monotherapy for secondary coronary artery disease prevention is reduced in elderly patients from 65 years of age onward.