Key result
Aspirin therapy for primary cardiovascular prevention should be individualized and considered only for patients <70 years with very high cardiovascular risk and low bleeding risk.
Why the study?
The role of aspirin for primary cardiovascular prevention is debated after recent trials showed ischemic reductions were largely counterbalanced by bleeding events.
Does aspirin therapy improve outcomes in primary cardiovascular prevention based on risk stratification?
Does aspirin therapy improve outcomes in primary cardiovascular prevention based on risk stratification?
Aspirin for primary cardiovascular prevention should be highly individualized, reserved for patients under 70 years of age with very high cardiovascular risk and low bleeding risk.
Supports individualized aspirin decisions in primary prevention for select high-risk patients; leaves open need for prospective validation of thresholds.
The need for aspirin therapy as part of primary prevention of cardiovascular (CV) disease is currently being highly debated, especially after 3 studies in different settings reported that a reduction in ischemic events is largely counterbalanced by an increase in bleeding events. One possible explanation for these results is the progressive reduction in the risk of major adverse cardiovascular events (MACE) as a result of primary prevention, which has accompanied global education programs that have led to patients smoking less, exercising more, and increasingly undertaking lipid-lowering therapies. Based on a meta-regression of the benefits and harmful effects of aspirin therapy in primary prevention as a function of the 10-year risk of MACE, we favor a differentiated and personalized approach that acknowledged differences between patients and emphasized an individualized assessment of benefits and risks. Following general preventive measures (physical exercise, cessation of smoking, treatment of hypertension and hypercholesterolemia, etc.), an individualized approach to prescribing aspirin is still warranted. When patients are less than 70 years of age, clinicians should assess the 10-year CV risk. Aspirin treatment should be considered only when the CV risk is very high and the bleeding risk is low, after taking into account the patient's preferences.
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Alberto Aimo (2019) conducted a review in Primary cardiovascular prevention. Aspirin was evaluated. Aspirin therapy for primary cardiovascular prevention should be individualized and considered only for patients <70 years with very high cardiovascular risk and low bleeding risk.
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