Podcast episode 116 (in German)

Aspirin for prevention – more deaths than on placebo

October 24, 2026

In the largest trial of aspirin in healthy older people, more people died in the aspirin group than on placebo. This episode separates the two groups who take the same tablet and explains why the result applies to only one of them.

What it is about

Aspirin after a heart attack or stroke, secondary prevention, is well supported, and this episode changes nothing about that. It is about people without cardiovascular disease who take a tablet as a precaution. A pooled analysis from 2009 already showed a gain for them of the same order of magnitude as the price paid in bleeding. The ASPREE trial asked the question again in 2018 in healthy people aged 70 and over: no benefit for the primary endpoint, none for the heart, but more serious bleeding and higher mortality, driven by cancer deaths. Since 2022 the US Preventive Services Task Force has advised against starting it from age 60. Not starting is something different from stopping: anyone who takes aspirin after a heart attack, a stroke or on medical advice does not stop it.

Key points

After a heart attack or stroke, aspirin lowers serious vascular events from 8.2 to 6.7 percent per year, according to a pooled analysis of 16 trials with 17,000 people with prior disease.
In healthy people, the same analysis of 6 trials with 95,000 people found 0.51 versus 0.57 percent per year, while bleeding rose from 0.07 to 0.1 percent.
In ASPREE with 19,114 participants, mean age 74, the primary endpoint after a median of 4.7 years was 21.5 versus 21.2 events per 1,000 person-years.
With 1,052 deaths, mortality on aspirin was 12.7 versus 11.1 per 1,000 person-years, hazard ratio 1.14, confidence interval 1.01 to 1.29.
Cancer deaths were 3.1 versus 2.3 percent, hazard ratio 1.31 — a finding from a post hoc, unplanned analysis of causes of death.
The bleeding finding, by contrast, was planned: 8.6 versus 6.2 serious bleeds per 1,000 person-years, hazard ratio 1.38; for the heart 0.95, without a clear difference.
In a 2023 US survey of 2,657 people aged 50 to 80, 14.5 percent took aspirin regularly without cardiovascular disease, 22.7 percent of them without a medical recommendation.

Where the data stop

The cancer signal is the weakest part. It comes from an unplanned analysis, and the authors themselves call it unexpected and to be read with caution. Followed up over 10 years, cancer mortality remained elevated at 1.15, although no more people developed cancer (0.98); cancers in the aspirin group were more often detected only at stage 4. That aspirin might accelerate progression in older people is a hypothesis of the authors, not a finding. After stopping, the difference was gone (1.02). The known protection against colorectal cancer, established in middle-aged people, was also not found in those over 70 (1.01).

The results apply to healthy people aged 70 and over, in the US to Black and Hispanic people aged 65 and over. For 40- to 59-year-olds at high risk, the guideline sees an individual decision with a small net benefit. It contains no sentence about stopping; anyone already taking it should clarify this with their doctor. In the survey, 29.4 percent believed aspirin lowers the risk of dementia — dementia was part of ASPREE’s primary endpoint, with no difference.

Listen (in German)

Listen on Spotify Listen on Apple Podcasts Listen on Amazon Music

Published on October 24, 2026.

The topic in the database

Supported after a heart attack or stroke. In healthy people aged seventy and over, the largest trial found no benefit – and more deaths than on placebo.Aspirin for prevention (primary prevention)

All episodes in the app (German)

Information only, not medical advice and not a usage or dosage recommendation. Prescription-only and unapproved substances belong in the hands of a physician. Last updated: 2026-09-22.