[Aspirin for primary prevention of cardiovascular diseases--lessons from recent studies]

Aspirin is recommended as a primary prevention treatment of cardiovascular disease for the population at risk. The American Heart Association guidelines of 2002 recommended aspirin as primary prevention for patients with a cardiovascular risk of over 10% per decade (according to the Framingham study). Over the last few years, several double-blind controlled studies analyzed the affect of aspirin for primary prevention in several population groups. For example, while the effect of aspirin in men is mainly in lowering myocardial infarction risk, the effect in women is mainly in lowering the risk of cerebrovascular accident. In view of those studies, the U.S. Preventive Services Task Force (USPSTF) published a gender-based set of guidelines for the use of aspirin as primary prevention. Despite the studies and the USPSTF guidelines, controversy still persists regarding aspirin as a primary prevention therapy. The available use of other therapeutics as a measure for primary prevention and the different harm-benefit ratio scaling for the aspirin effect, all contribute to the controversy. These considerations have led some of the authors of articles in this edition to recommend against administering aspirin as primary prevention. Studies in diabetic patients have shown inferior results compared to the general population.

Despite tens of thousands of patients over the years, controversy over aspirin as a primary prevention measure still prevails. Therefore, the physician who decides on aspirin for primary prevention has to base his decision on the unique characteristics of each specific patient.