Researchers have outlined a statistical analysis plan to investigate whether lipoprotein(a) [Lp(a)] levels and oxidized phospholipids can predict who benefits most from daily low-dose aspirin. The plan leverages blood samples from 72% of ASPREE trial participants—a major study of aspirin for primary prevention in older adults—to measure Lp(a) and related biomarkers including oxidized phospholipids on apoB-100, apo(a), and plasminogen carriers. This analysis framework represents a sophisticated attempt to personalize aspirin therapy based on individual lipid profiles rather than applying blanket recommendations. Lp(a) has gained recognition as a key cardiovascular risk factor, with elevated levels promoting atherothrombosis through multiple pathways including interference with fibrinolysis. The researchers' preliminary genetic findings suggesting aspirin benefits vary by Lp(a)-associated genotypes add compelling rationale for this biomarker-driven approach. If validated, this could transform clinical practice by identifying elderly patients most likely to benefit from aspirin while avoiding unnecessary bleeding risks in those unlikely to benefit. However, as this is a preprint statistical plan rather than completed results, the actual findings remain unknown and await peer review. The work could provide crucial evidence for precision medicine approaches to cardiovascular prevention.