Recommending aspirin for primary prevention of cardiovascular disease

Abstract

The benefit of aspirin use for secondary prevention of cardiovascular disease is well established; the efficacy of aspirin use for primary prevention, however, is less evident. Trials evaluating aspirin for primary prevention provide little direction regarding when it should be used. Certain populations, such as patients who are at higher risk for cardiovascular disease or have multiple risk factors, may be candidates for low-dose aspirin therapy when the benefits of taking aspirin for cardiovascular protection outweigh the harms. Other high-risk populations, such as patients with diabetes and those with a 10-year cardiovascular risk exceeding 10%, may also benefit from low-dose aspirin therapy. Aspirin has long been used for its anti-inflammatory and analgesic properties, and more recently it has been used for its antithrombotic effect in reducing cardiovascular disease risk. Making a recommendation for aspirin use in secondary prevention for most patients is clear: Aspirin is a mainstay of long-term drug therapy to reduce the risk of myocardial infarction (MI), stroke, and death related to vascular causes following a cardiovascular event. However, the use of aspirin for primary prevention in patients with no history of cardiovascular disease needs to be clarified. This article will provide a detailed examination of the evidence surrounding this clinical controversy.