Introduction

It is 30 years since the first randomised trial was published showing a link between aspirin and myocardial infarction.1 We believe that the evidence now supports more widespread use of aspirin prophylaxis, and there needs to be a strategy to inform the public and enable older people to make their own decision. The evidence focuses on a crucial question—namely, at what age does the balance between benefit and risk justify low dose aspirin prophylaxis? Of further relevance is a possible reduction of cancer and dementia by aspirin.

Recommendations for aspirin prophylaxis

Although several groups have recommended aspirin prophylaxis based on age alone, including a recommendation of daily aspirin for everyone over 50,2 3 cardioprotection is usually given only to people at vascular risk. Many formulas are available to assess risk, and one of these4 is the basis of the recommendation that prophylactic aspirin be considered if the five year risk of a vascular event is 3% or more.5

Application of the Framingham risk formula4 to the …