From the Guidelines
A 67-year-old male with hyperlipidemia and a smoking history should likely continue taking aspirin daily for ASCVD prevention, but with careful consideration of his individual bleeding risk. Based on the most recent guidelines from the dcrm 2.0 study 1, patients with no known ASCVD but ≥2 major risk factors, which would include this patient due to his age, hyperlipidemia, and smoking history, are recommended to take aspirin 75–100 mg daily if they have a low bleeding risk. Given the patient's history, it's crucial to assess his bleeding risk to determine if the benefits of aspirin therapy outweigh the risks. Key factors to consider include:
- His specific risk factors for bleeding, such as gastrointestinal issues or the use of other medications that could increase bleeding risk
- The presence of any established ASCVD, which would shift the consideration towards secondary prevention where aspirin is more clearly beneficial
- Other preventive strategies that should be optimized, including smoking cessation, statin therapy for hyperlipidemia, blood pressure control, and lifestyle modifications. It's essential for the patient to consult with his healthcare provider to evaluate his individual risk-benefit profile and make an informed decision about continuing aspirin therapy 1.
From the FDA Drug Label
Warnings Stomach bleeding warning: This product contains an NSAID, which may cause severe stomach bleeding The chance is higher if you are age 60 or older The FDA drug label does not answer the question.
From the Research
Aspirin Use for ASCVD Prevention in a 67-Year-Old Male with HLD and Smoking History
- The patient has been taking aspirin daily for ASCVD prevention, but new recommendations may affect this decision.
- A study published in 2021 2 found no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily.
- Another study from 2020 3 suggested that aspirin is associated with a reduction in ASCVD when used for primary prevention, but the treatment effect does not increase as ASCVD risk increases.
- A 2025 review 4 found growing evidence for a benefit with aspirin therapy in individuals with elevated Lp(a) without clinical ASCVD, but acknowledged the limitations of available data and the need for shared decision making.
- A 2019 article 5 revisited the role of aspirin for primary prevention of cardiovascular disease and proposed a decisional framework for clinicians to support prescription of aspirin in primary prevention.
- A 2024 secondary analysis of the ADAPTABLE trial 6 found no significant sex-specific differences in the effectiveness and safety of 2 aspirin doses for secondary prevention of ASCVD events.
Considerations for Continuing Aspirin Use
- The patient's history of smoking and HLD may increase their risk for ASCVD, but the benefits of aspirin use must be weighed against the potential risks of bleeding.
- The patient's age and medical history should be taken into account when making a decision about continuing aspirin use.
- Shared decision making between the patient and their clinician is recommended to determine the best course of action.
Aspirin Dosing Considerations
- The 2021 study 2 found no significant differences in cardiovascular events or major bleeding between patients assigned to 81 mg and those assigned to 325 mg of aspirin daily.
- The 2024 secondary analysis of the ADAPTABLE trial 6 also found no significant differences in the effectiveness and safety of 2 aspirin doses for secondary prevention of ASCVD events.