What is the role of aspirin in preventing cardiovascular disease (CVD)?

Updated: May 25, 2018
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Low-dose aspirin use (75-100 mg/d) has been shown to decrease the recurrence of myocardial infarction (MI) and stroke. However, those benefits have to be balanced against the increased risk of gastrointestinal (GI) bleeding.

In 2014, the US Food and Drug Administration (FDA) denied a request by Bayer AG to change the labeling on packages in order to market aspirin's value in preventing MI in people who have never had cardiovascular disease (CVD). The FDA concluded that the data do not support the use of aspirin as primary prevention by people who have not had an MI, stroke, or CVD symptoms. [20]

The 2009 US Preventive Services Task Force (USPSTF) guideline recommends use of aspirin in men ages 45 to 79 years and women ages 55 to 79 years when the potential benefit due to a reduction in MIs (in men) and ischemic strokes (in women) outweighs the potential harm due to an increase in gastrointestinal hemorrhage. Update of these recommendations is currently in progress. [21]

Since 2002, the American Heart Association (AHA) has recommended the use of aspirin for cardiovascular prophylaxis among persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (a 10-year risk for cardiovascular events of 10% or greater). [22] In its 2011 update of guidelines for prevention of CVD in women, the AHA recommended low-dose aspirin use for the following populations [23] :

  • Women with diabetes
  • Women 65 years of age and older if blood pressure is controlled and benefit for ischemic stroke and myocardial infraction outweighs risk of gastrointestinal bleeding and hemorrhagic stroke

The guidelines included a recommendation against the routine use of aspirin in healthy women younger than 65 years old to prevent MI. However, low-dose aspirin may be useful in this group for ischemic stroke prevention. [23]

Joint AHA/American Stroke Association guidelines for the primary prevention of stroke recommend against aspirin in men but state that aspirin can be useful for primary prevention of stroke in women whose risk is sufficiently high for the benefits to outweigh the harms of treatment. [24]

The 2012 guidelines of American College of Chest Physicians recommend low-dose aspirin (75-100 mg/day) over no aspirin in patients older than 50 years without symptomatic CVD. [25]

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