Education And Debate For and against

Aspirin for everyone older than 50?

BMJ 2005; 330 doi: (Published 16 June 2005) Cite this as: BMJ 2005;330:1440
  1. Peter Elwood (, chairman1,
  2. Gareth Morgan, secretary1,
  3. Ginevra Brown, statistician1,
  4. Janet Pickering, statistician1
  1. 1 Welsh Aspirin Group, Department of Epidemiology, Statistics and Public Health, Cardiff University, Llandough Hospital, Penarth CF64 2XW
  1. Correspondence to: P Elwood
  • Accepted 22 March 2005

Current population screening for vascular disease is neither efficient nor effective. Peter Elwood and colleagues believe we should have a public information strategy highlighting the benefits (and risks) of aspirin for older people, but Colin Baigent argues that the evidence of benefit is not yet strong enough


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 …

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