News · Longevity & Aging
Daily aspirin did nothing for healthspan in 19,114 older adults
The ASPREE trial randomized healthy over-70s to low-dose aspirin or placebo and tracked the first serious illness. The two groups were indistinguishable.
Based on a peer-reviewed randomized placebo-controlled trial reported in Age and Ageing
- ASPREE randomized 19,114 community-dwelling adults, aged 70 and over in Australia and 65 and over for US minority ethnic groups, to 100 mg of aspirin daily or placebo; this healthspan analysis was published in 2026.
- Loss of healthspan was defined as the first occurrence of cardiovascular disease, diabetes, dementia, cancer, or death.
- Over a median 4.7 years, 5,835 participants (30.5%) lost healthspan by that definition.
- The rate was 82.1 events per 1,000 person-years on aspirin and 82.7 on placebo.
- There was no meaningful difference between the groups (HR, 0.98; 95% CI, 0.92-1.05).
- Older participants, men, smokers, and those with hypertension or frailty were more likely to lose healthspan regardless of treatment.
- Participants were healthy at entry, free of major disease with a life expectancy over five years, so this says nothing about aspirin for people who already have heart disease.
- The authors conclude that future work should look at lifestyle and behavioral interventions instead.
A daily low-dose aspirin was for years the closest thing to a free lunch in preventive medicine: cheap, familiar, and supposedly protective against everything inflammation touches. A new analysis of the ASPREE trial tested that against a placebo in 19,114 healthy older adults and found the two arms nearly identical.
The rationale was reasonable. Inflammation is a shared pathogenic pathway underlying multiple chronic conditions and contributes to a loss of healthspan, and aspirin reduces inflammation. The study set out to evaluate the effect of low-dose aspirin on the loss of healthspan in older individuals.
A trial built for exactly this question
ASPREE was a double-blind, placebo-controlled trial assessing the effect of daily low-dose aspirin for primary prevention. Primary prevention means the participants had not already had a cardiovascular event, which is the population where the question was genuinely open.
Recruitment was deliberately of the well. Community-dwelling participants aged 70 years and over, or 65 and over for United States minority ethnic groups, were recruited from Australia and the US, and eligible participants were initially free of major diseases with a life expectancy of more than five years.
They were randomly assigned to receive 100 mg of aspirin daily or a placebo.
Defining the finish line
The endpoint is the interesting design choice. Rather than counting deaths, the researchers counted the first serious thing to go wrong.
Loss of healthspan was defined as the first occurrence of cardiovascular disease, diabetes, dementia, cancer, or death.
That is a demanding target for any single drug, because it asks aspirin to move five different disease processes at once. It is also the outcome people actually care about, which is not how long you live but how long you stay well.
The result
A total of 19,114 participants were followed for a median of 4.7 years, and 5,835 participants (30.5%) experienced a loss of healthspan. Nearly a third, so the trial had no shortage of events to detect a difference with.
There was no difference to detect. The rate of healthspan loss was 82.1 and 82.7 events per 1,000 person-years in the aspirin and placebo groups, respectively.
Those two numbers differ by less than one percent, in the direction of aspirin, and the formal comparison confirms it: there was no evidence of a substantial difference in the risk of healthspan loss between the aspirin and placebo groups, at 0.98 with a range from 0.92 to 1.05.
A range that tight, sitting on 1.00, is not a study that failed to find an effect for want of power. It is a study that looked carefully and found nothing.
What did predict losing healthspan
The same things that always do. Participants who were older, male, smokers, or had hypertension, or frailty were more likely to experience healthspan loss during the trial.
None of those is a surprise, and that is rather the point. The predictors were the well-known ones, and the intervention was not among them.
The boundaries of this finding
The population is specific: healthy, community-dwelling, over 70, free of major disease at entry. Aspirin’s role for people who have already had a heart attack or stroke is a separate question with a different and largely favorable answer, and nothing here bears on it.
Anyone currently taking aspirin under medical advice should not stop on the strength of this. Stopping abruptly after a cardiovascular event carries real risk, and the decision belongs with a clinician who knows the individual history.
The follow-up is also under five years, and the healthspan definition lumps a cancer diagnosis together with a diabetes diagnosis as though they were equivalent. They are not, and a composite endpoint can obscure movement in opposite directions among its components.
Why it still lands
ASPREE has now produced the same answer several ways. Earlier reports found no benefit for disability-free survival and more major bleeding. This one adds healthspan to the list.
The authors’ closing line is the practical one: future studies should explore lifestyle and behavioral interventions to extend healthspan.
Which is a quieter recommendation than a pill, and considerably harder to sell.
People also ask
What is healthspan, and how was it measured here?
Healthspan is the portion of life spent free of serious chronic disease, as distinct from lifespan, which counts years regardless of health. This analysis defined it as the time until the first of five events: cardiovascular disease, diabetes, dementia, cancer, or death. That is a blunt but honest definition, because it treats a first cancer diagnosis and a first stroke as equivalent endpoints when they clearly differ in what follows.
Does this mean nobody should take aspirin?
No, and the distinction matters a great deal. ASPREE enrolled people who were healthy and free of established cardiovascular disease, which is called primary prevention. Aspirin remains standard care for many people who have already had a heart attack or stroke, where the calculation is entirely different. Nobody taking aspirin on medical advice should stop based on this study; stopping abruptly after a cardiovascular event carries its own risk.
Why did people believe daily aspirin helped?
Because aspirin genuinely reduces inflammation and clotting, and inflammation is implicated in most age-related disease. The reasoning was plausible enough that daily aspirin became routine for millions of healthy older adults. ASPREE was designed to test that reasoning directly, and its earlier reports already found no reduction in disability-free survival alongside more major bleeding. This analysis extends the same null to healthspan.
Is 4.7 years long enough to see an effect?
It is a fair question and a real limitation. Median follow-up was 4.7 years, which is short for processes that unfold over decades. That said, nearly a third of participants reached an endpoint in that window, so the trial was not short of events. A treatment with a substantial effect would have had ample opportunity to show one.
What does the study suggest instead?
The authors point to lifestyle and behavioral interventions as the more promising direction. That is consistent with other work in this area, including trials finding structured lifestyle programs outperform drugs at preventing accumulated chronic conditions. This is general information rather than medical advice, and anyone reviewing their own medication should do it with their clinician.
References
- Zheng HT, Phyo AZZ, Wu Z, et al. Effect of aspirin on healthspan in community-dwelling older adults: the ASPirin in reducing events in the elderly study. Age and Ageing (2026).
- National Institute on Aging. Aspirin for Reducing Your Risk of Heart Attack and Stroke.
- US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease.