Home › Research › Treatments
Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States
Tzimas, G.; Vanghelof, J. C.; Mohammed, A.; Raicu, D. S.; Du, L.; Ernst, M. E.; Warner, E. T.; Chan et al.. medRxiv (preprint), 2026-08-27
Topic: Risk, prevention and care in population studies
ImportanceThe ASPREE randomized trial found no overall benefit of low-dose aspirin for disability-free survival among older adults. However, individual estimates in pre-specified subgroups indicated potential benefit among racial and ethnic minoritized participants in the United States (US). ObjectiveTo evaluate whether the effect of low-dose aspirin vs placebo on disability-free survival differed across US Black and Hispanic ASPREE participants using individualized treatment-effect estimation. Design, Setting, and ParticipantsPost hoc clinical trial analysis of ASPREE, a randomized, double-blind, placebo-controlled clinical trial of daily low-dose aspirin vs placebo. This analysis included US ASPREE participants who self-identified as non-Hispanic Black or Hispanic, were aged 65 years or older, and had complete baseline predictor and outcome data. InterventionsRandomization to daily 100-mg aspirin or placebo. Main Outcomes and MeasuresThe primary outcome was loss of disability-free survival, defined as death, persistent physical disability, or dementia. Individualized treatment effects were estimated post hoc using a Random Survival Forest X-learner. Heterogeneity was evaluated on the relative scale with Cox proportional hazards models and on the absolute scale with 5-year risk differences. ResultsAmong 2411 US ASPREE participants, 1270 were included in the Black and Hispanic analytic cohort (897 non-Hispanic Black and 373 Hispanic participants; mean age, 71.8 years). Aspirin was associated with lower risk of disability-free survival loss compared with placebo (hazard ratio [HR], 0.65; 95% CI, 0.45-0.93). In model-derived tertiles, aspirin was associated with lower risk in the greatest predicted-benefit group (HR, 0.36; 95% CI, 0.19-0.71; 5-year absolute risk difference [ARD], -11.1 percentage points; 95% CI, -22.0 to -0.1) but not in the lowest predicted-benefit group (HR, 1.26; 95% CI, 0.70-2.27; ARD, +3.9 percentage points; 95% CI, -5.9 to 13.6). Conclusions and RelevanceIn these analyses of US Black and Hispanic ASPREE participants, aspirin effects on disability-free survival appear to be heterogeneous, with benefit concentrated in a subset of participants. Because these findings are from post-hoc models, they should be externally validated before being incorporated into clinical decision-making. Trial RegistrationClinicalTrials.gov Identifier: NCT01038583; https://clinicaltrials.gov/study/NCT01038583
Key findings
- ImportanceThe ASPREE randomized trial found no overall benefit of low-dose aspirin for disability-free survival among older adults.
- Aspirin was associated with lower risk of disability-free survival loss compared with placebo (hazard ratio [HR], 0.65; 95% CI, 0.45-0.93).
- In model-derived tertiles, aspirin was associated with lower risk in the greatest predicted-benefit group (HR, 0.36; 95% CI, 0.19-0.71; 5-year absolute risk difference [ARD], -11.1 percentage points; 95% CI, -22.0 to -0.1) but not in the lowest predicted-benefit group (HR, 1.26; 95% CI, 0.70-2.27; A
- Because these findings are from post-hoc models, they should be externally validated before being incorporated into clinical decision-making.
Why it matters
In this post hoc analysis of the ASPREE trial, low-dose aspirin was associated with lower risk of loss of disability-free survival among US Black and Hispanic participants, with the largest benefit in the greatest predicted-benefit group. This is a subgroup analysis of a trial that found no overall benefit, so it does not establish aspirin as a way to prevent dementia.
New to this subject? Start with our plain-English guide: Treatments →
Study details
- Study designrandomized controlled trial
- Evidence strengthHigh
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 41 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on impact for its field and year, so that was left out: it earned 39 of the 94 points we could judge it on, which is 41 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv (preprint)) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 11 / 12 | A randomised controlled trial |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 1 / 2 | Randomised (as stated in the record) |
| Times cited | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Raj C. Shah: h-index 80 (OpenAlex, whole career) |
| Institution's track record | 3 / 3 | Harvard University: institution h-index 3,235 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 9 institution(s) in 2 countries |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 39 / 94 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 39 of the 94 points we could judge it on is 41 out of 100. |
| Total | 41 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Tzimas, G., Vanghelof, J. C., Mohammed, A., Raicu, D. S., Du, L., Ernst, M. E., et al. (2026). Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States. medRxiv (preprint). https://doi.org/10.64898/2026.08.24.26361036
Vancouver
Tzimas G, Vanghelof JC, Mohammed A, Raicu DS, Du L, Ernst ME, et al. Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States. medRxiv (preprint). 2026. doi:10.64898/2026.08.24.26361036.
BibTeX
@article{tzimas2026-4c0acdbc,
author = {Tzimas, G. and Vanghelof, J. C. and Mohammed, A. and Raicu, D. S. and Du, L. and Ernst, M. E. and Warner, E. T. and Chan and others},
title = {{Aspirin and healthy longevity within racial and ethnic minoritized older adults in the United States}},
journal = {medRxiv (preprint)},
year = {2026},
doi = {10.64898/2026.08.24.26361036},
url = {https://doi.org/10.64898/2026.08.24.26361036}
}