Aspirin for primary prevention of cardiovascular disease: is it time to move on?

Aspirin has been used for decades for the primary prevention of cardiovascular disease. However, several recent trials evaluating the benefits and risks of aspirin for primary prevention have been published, creating the need to reevaluate this important topic.

Three large randomized trials studying aspirin in various primary prevention populations including individuals with diabetes, an elderly population, and middle-aged adults at high cardiovascular risk have recently been completed. These trials found a small benefit for individuals with diabetes and no benefit in the elderly and high risk middle-aged adult populations. Additionally, all three trials demonstrated a clear increase in risk for bleeding events.

The recent trials confirm that, in modern primary prevention populations, the cardiovascular benefit of aspirin is small and comes with a clear increase in risk for bleeding. For the majority of adults without established cardiovascular disease, the risk of a daily aspirin outweighs the benefit.