Aspirin for primary prevention of cardiovascular disease: Advice for a decisional strategy based on risk...

Area of Science:

• Cardiology
• Preventive Medicine
• Pharmacology

Background:

• The role of aspirin in primary prevention of cardiovascular (CV) disease is under intense debate.
• Recent studies indicate that reductions in ischemic events with aspirin are offset by increased bleeding events.
• Improved global preventive measures (smoking cessation, exercise, lipid management) have lowered baseline CV risk.

Purpose of the Study:

• To analyze the benefits and harms of aspirin therapy for primary CV prevention.
• To evaluate aspirin's efficacy as a function of the 10-year risk of major adverse cardiovascular events (MACE).
• To advocate for a personalized and differentiated approach to aspirin prescribing.

Main Methods:

• Conducted a meta-regression analysis of aspirin's benefits and harms.
• Examined aspirin's effectiveness relative to the 10-year MACE risk.
• Considered patient-specific factors including CV and bleeding risks.

Main Results:

• Aspirin's net benefit in primary prevention is influenced by the individual's 10-year MACE risk.
• The balance of benefits versus bleeding risks necessitates an individualized risk-benefit assessment.
• General preventive strategies remain paramount.

Conclusions:

• A personalized approach to aspirin therapy in primary CV prevention is warranted.
• For patients under 70, clinicians should assess 10-year CV risk.
• Aspirin should be considered only for very high CV risk and low bleeding risk individuals, respecting patient preferences.