Aspirin for Primary Prevention of Cardiovascular Disease Events

• Published in: Pharmacotherapy Vol. 32; no. 11; pp. 1020 - 1035
• Main Authors: Nemerovski, Carrie W., Salinitri, Francine D., Morbitzer, Kathryn A., Moser, Lynette R.
• Format: Journal Article
• Language: English
• Published: Boston, MA Blackwell Publishing Ltd 01-11-2012; Pharmacotherapy
• Subjects: aspirin; Aspirin - adverse effects; Aspirin - therapeutic use; Biological and medical sciences; cardiovascular disease; cardiovascular disease prevention; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cyclooxygenase Inhibitors - adverse effects; Cyclooxygenase Inhibitors - therapeutic use; Evidence-Based Medicine; Female; Hemorrhage - chemically induced; Hemorrhage - epidemiology; Humans; Male; Medical sciences; Meta-Analysis as Topic; Pharmacology. Drug treatments; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Practice Guidelines as Topic; Primary Prevention; Randomized Controlled Trials as Topic; Risk; Sex Characteristics; Prostaglandin-endoperoxide synthase; Enzyme; Enzyme inhibitor; Cardiovascular disease; Acetylsalicylic acid; Antiplatelet agent; Non steroidal antiinflammatory agent; Prevention; Analgesic; Primary; Antipyretic; primary prevention; aspirin; Oxidoreductases; Salicylates; cardiovascular disease prevention
• ISSN: 0277-0008; 1875-9114
• DOI: 10.1002/phar.1127

Aspirin has been used for the prevention and treatment of cardiovascular disease (CVD) for several decades. The efficacy of aspirin for secondary prevention of cardiovascular disease is well established, but the clinical benefit of aspirin for primary prevention of CVD is less clear. The primary literature suggests that aspirin may provide a reduction in CVD events, but the absolute benefit is small and accompanied by an increase in bleeding. For aspirin to be beneficial for an individual patient, the risk of a future CVD event must be large enough to outweigh the risk of bleeding. The estimation of CVD risk is multifaceted and can involve numerous risk scores and assessments of concomitant comorbidities that confer additional CVD risk. Numerous guidelines provide recommendations for the use of aspirin for primary prevention, but they often contradict one another despite being based on the same clinical trials. Additional literature suggests that the presence of comorbidities that increase CVD risk, such as diabetes mellitus, asymptomatic peripheral arterial disease, or chronic kidney disease, does not ensure that aspirin therapy will be beneficial. Ongoing clinical trials may provide additional insight, but until more data are available, an individualized assessment of CVD risk with careful evaluation of risk and benefit should be performed before recommending aspirin therapy for primary prevention of CVD.