Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States

George Tzimas and colleagues reanalyzed the ASPREE randomized trial in older US participants who self-identified as non-Hispanic Black or Hispanic. The analytic cohort included 1,270 people, 897 Black and 373 Hispanic participants, with a mean age of 71.8 years. Participants had been randomized to 100 mg aspirin daily or placebo. The primary outcome combined death, persistent physical disability, or dementia. Aspirin was associated with lower risk of loss of disability-free survival, with a hazard ratio of 0.65 (95% CI 0.45 to 0.93). A model-derived highest predicted-benefit tertile had a hazard ratio of 0.36 (95% CI 0.19 to 0.71) and a five-year absolute risk difference of -11.1 percentage points. The lowest predicted-benefit tertile did not show benefit. This is a post-hoc model-based subgroup result from a preprint. It does not overturn the overall ASPREE finding of no disability-free-survival benefit. The subgroup signal needs external validation before it changes practice.

In these analyses of US Black and Hispanic ASPREE participants, aspirin effects on disability-free survival appear to be heterogeneous, with benefit concentrated in a subset of participants. Because these findings are from post-hoc models, they should be externally validated before being incorporated into clinical decision-making.