Sugawara M, et al. - In this post hoc sub-analysis of data from the randomized Japanese Primary Prevention Project, researchers investigated if once-daily low-dose aspirin vs no aspirin reduced the risk of cardiovascular events (CVEs) in patients aged ≥ 70 years with atherosclerotic risk factors. Patients aged < 70 years (young-old) or ≥ 70 years (old) with hypertension, dyslipidemia, or diabetes were randomized 1:1 to receive 100-mg enteric-coated aspirin once daily or no aspirin plus standard of care. They assessed a composite of death from cardiovascular causes plus nonfatal stroke and nonfatal myocardial infarction as the primary outcome, and a composite of the primary outcome plus transient ischemic attack, angina pectoris, and arteriosclerotic disease requiring medical or surgical intervention as the secondary outcome. Aspirin treatment led to no reduction in the risk of the primary or secondary outcomes in old patients. Within a high CVE risk elderly population subgroup, CVEs may reduce in relation to aspirin treatment. The investigators recommend caution when considering aspirin treatment in such a group due to the increased risk of intracranial hemorrhage, severe extracranial hemorrhage requiring hospitalization or transfusion, and gastrointestinal bleeding in old patients receiving aspirin therapy.