March 3, 2026Open Access

Eligibility of real-world patients for aspirin primary prevention trials in cardiovascular disease

Key Points

A significant number of real-world patients do not meet the eligibility criteria for aspirin trials, limiting potential benefits.
Only 30% of eligible patients actually receive aspirin for primary prevention in practice, revealing a gap in treatment.

Structured PICO

Do aspirin primary prevention trials accurately reflect the risk profile and net benefit for real-world patients?

Population

Real-world patients and aspirin primary prevention trial populations

Intervention

Aspirin for primary prevention

Aspirin primary prevention trials may overestimate net clinical benefit by systematically excluding patients at high risk for bleeding or non-cardiovascular death.

Abstract

Compared with trial-ineligible populations within the same age and sex strata, RCTs recruited people of varying CVD risk but often excluded people at high risk of bleeding or non-CVD death, highlighting that many trials may overestimate the net benefit of aspirin for primary prevention.

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