Impact of Chronic Low-Dose Acetyl‑Salicylic Acid on Carotid Arteriosclerosis and Systemic Lipofuscin Burden in Older Adults: A Cross-Sectional Study

Background: Acetyl salicylic acid (aspirin) is routinely taken at low dosages for vascular prophylaxis, but its antioxidant capacity to slow arteriosclerosis and lipofuscin accumulation has yet to be settled. Objectives: To compare carotid intima–media thickness (IMT) and circulating N retinylidene N retinylethanolamine (A2E)—a proxy for lipofuscin—in older adults chronically exposed to low-dose ASA with controls free of aspirin. Methods: A comparative cross-sectional study consecutively enrolled eighty ambulatory adults ≥ 60 years. ASA 75–100 mg day¹ was given to forty participants for ≥ 6 months, and forty participants received no antiplatelet therapy in the same period. At a single visit, a structured interview, physical examination, and fasting blood tests were completed. A blinded sonography measured carotid IMT with a 10 MHz linear probe and quantified plasma A2E by liquid chromatography–tandem mass spectrometry. However, our analysis was adjusted for age, sex, diabetes, systolic blood pressure, and statin use. Results: Groups were well matched for demographic and cardiometabolic variables. ASA users had a lower mean IMT compared to controls (0.79 ± 0.09 vs 0.83 ± 0.09 mm; p = 0.010). Plasma A2E was also lower in the ASA cohort (29.3 ± 7.4 nmol/L⁻¹ vs 34.0 ± 8.5 nmol/L⁻¹; p = 0.005). Chronic ASA exposure (after adjustment) independently predicted thinner IMT (β = –0.046 ± 0.013 mm; p = 0.001) and lower A2E (β = –3.5 ± 1.0 nmol L¹; p = 0.002). One ASA user had minor gastrointestinal bleeding; no intracranial haemorrhage was observed. Conclusion: The putative ASA mitigating effect on both arteriosclerotic remodeling and oxidative pigment accumulation was supported in an older outpatient population by association with slimmer carotid arterial walls and diminished circulating lipofuscin surrogate. Since causality is required and bleeding risk is a potential liability, these anti-senescence benefits need to be weighed in prospective studies.