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Thromb Haemost 2025; 125(11): 1159-1162
DOI: 10.1055/a-2580-6931
Letter to the Editor

Age-Related Clinical Efficacy of Aspirin for Primary Cardiovascular Prevention: A Systematic Review and Meta-analysis

Authors

  • Emanuele Valeriani 

    1   Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy
    2   Department of Infectious Disease, Azienda Ospedaliero-Universitaria Policlinico Umberto I, Rome, Italy

  • Howard D. Sesso

    3   Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States
    4   Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States
    5   Division of Aging, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, United States

  • Daniele Pastori

    6   Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
    7   IRCCS Neuromed, Pozzilli, Italy

  • Danilo Menichelli

    1   Department of General Surgery and Surgical Specialty, Sapienza University of Rome, Rome, Italy

  • Pasquale Pignatelli

    6   Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy

  • Francesco Violi 

    8   Sapienza University of Rome, Rome, Italy
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Background

Advanced age was associated with higher concentration of 11-dehydro-thromboxane (TX) B2 in both patients taking low-dose aspirin, or not.[1] This finding could suggest that cyclooxygenase (COX)-1—the enzyme that oxidizes arachidonic acid to the powerful aggregating molecule TXA2 [2]—is overactivated by aging and raises the question as to whether aspirin, which irreversibly inhibits COX-1,[3] may be less efficacious in an older population. However, further studies are needed to better understand the association between COX-1 expression, thromboxane production, and aspirin dosage in different subgroups of patients and to improve current therapeutic approach. To address this issue from a clinical point of view, we undertook a systematic review and meta-analysis to evaluate the differences in the efficacy of daily low-dose aspirin for primary cardiovascular prevention comparing old versus young subjects.

Authors' Contribution

Study conception and design: F.V.; data acquisition: E.V., D.M.; statistical analysis: E.V.; interpretation of the data: all authors; drafting of the manuscript: E.V., F.V.; critical revision of the manuscript for important intellectual content: all authors; Final approval of the manuscript: all authors.


Supplementary Material



Publication History

Received: 09 November 2024

Accepted: 10 April 2025

Accepted Manuscript online:
11 April 2025

Article published online:
06 May 2025

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