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Aspirin in primary prevention: a case for selective use
Myra Lewontin1, Antonio Abbate, Todd C Villines
1Cardiovascular Division, Department of Medicine, University of Virginia Health System, 1215 Lee St, Charlottesville, VA 22908.
Journal of Cardiovascular Pharmacology
|June 26, 2026
Summary
Low-dose aspirin may benefit specific individuals for primary cardiovascular prevention. Novel biomarkers help identify these groups for personalized risk-benefit discussions.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- Low-dose aspirin is established for secondary cardiovascular disease prevention.
- Primary prevention use is limited by uncertain benefit-risk balance and bleeding risks.
Purpose of the Study:
- To explore the role of novel biomarkers in identifying patient groups for primary aspirin prevention.
- To guide personalized cardiovascular risk-benefit assessments for aspirin therapy.
Main Methods:
- Review of current evidence on aspirin for primary cardiovascular prevention.
- Identification and discussion of novel cardiovascular risk biomarkers (imaging and laboratory).
Main Results:
- Aspirin's primary prevention benefit may not outweigh risks in the general population.
- Biomarkers like coronary artery calcium, carotid plaque, lipoprotein(a), and hs-CRP can refine risk stratification.
Conclusions:
- Novel biomarkers can identify subgroups with greater potential benefit from primary aspirin use.
- Biomarker-guided risk stratification can inform personalized aspirin therapy decisions and patient counseling.
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