Aspirin in primary prevention: a case for selective use

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.