Aspirin in Primary and Secondary Prevention of Cardiovascular Disease

Abstract

Aspirin is one of the most widely used drugs for the treatment of cardiovascular disease. While its use in patients with known cardiovascular disease has been supported with trials which have included mortality benefit, the utility of aspirin therapy in patients without established cardiovascular disease has been less clear. Early trials appeared to demonstrate benefit with the use of aspirin, but trials after 2000 did not consistently substantiate using aspirin for primary prevention of cardiovascular disease. Despite the lack of robust supportive evidence, aspirin was recommended and used extensively for primary prevention in patients at higher risk for cardiovascular events. More recently in 2018, results of three randomized, controlled trials: ARRIVE, ASCEND, ASPREE demonstrated modest to no benefit in preventing cardiovascular events and mortality with aspirin use for primary prevention. These trials also demonstrated an increased risk of bleeding in these patients who were on aspirin for primary prevention.