From the Guidelines
Aspirin is not recommended for routine primary prevention of cardiovascular events in most individuals, but may be considered in select adults aged 40-70 years with elevated cardiovascular risk and low bleeding risk, as evidenced by the most recent study in 2023 1. When considering aspirin for primary prevention, it is essential to weigh the potential benefits against the risks, particularly the increased risk of bleeding. The decision to use aspirin should be individualized, taking into account factors such as age, diabetes status, blood pressure, cholesterol levels, smoking status, and family history of premature heart disease.
- Key considerations include:
- Age: Aspirin may be considered in adults aged 40-70 years, but its use in older adults (>70 years) is generally not recommended due to the increased risk of bleeding 1.
- Cardiovascular risk: Aspirin may be considered in individuals with a 10-year cardiovascular risk >10%, as estimated by a risk calculator 1.
- Bleeding risk: Aspirin should be used with caution in individuals with increased bleeding risk factors, such as prior bleeding, concurrent anticoagulant or NSAID use, or uncontrolled hypertension 1.
- The typical dose of aspirin for primary prevention is low-dose, ranging from 81-100 mg daily 1.
- Aspirin works by inhibiting platelet aggregation, thereby reducing clot formation that could lead to heart attacks and strokes. However, this same mechanism increases bleeding risk, particularly gastrointestinal bleeding and hemorrhagic stroke 1.
- The modest cardiovascular benefits of aspirin in primary prevention often do not outweigh the bleeding risks, especially in older adults and those with increased bleeding risk factors 1.
From the Research
Aspirin for Primary Prevention of Cardiovascular Events
Aspirin (acetylsalicylic acid) is recommended for primary prevention of cardiovascular events in specific patient populations. The decision to use aspirin for primary prevention should be based on an individualized assessment of the patient's cardiovascular risk and bleeding risk.
Patient Selection
The following factors should be considered when selecting patients for aspirin therapy for primary prevention:
- Cardiovascular risk: Patients with a 10-year cardiovascular risk of 10% or higher may benefit from aspirin therapy 2
- Bleeding risk: Patients with an increased risk of bleeding should not be treated with aspirin 3, 2
- Age: Patients under 70 years of age may be considered for aspirin therapy 3
- Comorbidities: Patients with diabetes, hypertension, or hyperlipidemia may be at higher risk for cardiovascular events and may benefit from aspirin therapy 4, 5
Aspirin Dosing and Formulation
The recommended dose of aspirin for primary prevention is 75-100 mg per day 6. The formulation of aspirin (e.g., enteric-coated or buffered) may also be considered to minimize gastrointestinal side effects.
Clinical Decision Support Tools
Clinical decision support tools, such as the Aspirin-Guide, can help clinicians assess the patient's cardiovascular risk and bleeding risk and make informed decisions about aspirin therapy for primary prevention 6.
Key Considerations
- The benefit of aspirin therapy for primary prevention must be weighed against the risk of bleeding 5, 3
- Patients should be closely monitored for signs of bleeding or other adverse effects while taking aspirin 4, 2
- Aspirin therapy should be individualized based on the patient's unique risk factors and medical history 3, 6