The Case Against Routine Aspirin Use for Primary Prevention in Low-Risk Adults

Additionally, a statistically significant increase in gastrointestinal and other extracranial bleeding events occurred with aspirin therapy (0.10 versus 0.07 percent per year for aspirin and control, respectively; number needed to harm = 3,334).1 Even among patient populations traditionally thought to be at high risk of cardiovascular events, such as persons with diabetes mellitus or peripheral vascular disease, aspirin use does not clearly provide benefit in the primary prevention setting. The USPSTF also states that the evidence is insufficient to recommend the prophylactic use of aspirin in patients 80 years and older.6 Accordingly, recent recommendations from a joint American Diabetes Association/American Heart Association/American College of Cardiology Foundation consensus statement suggested that use of aspirin as primary prevention in persons with diabetes should be reserved for those with a 10-year risk of cardiovascular events that is greater than 10 percent.7 In summary, a policy of generalized aspirin use in adults for the primary prevention of CVD is probably not warranted. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation [published corrections appear in Diabetes Care. 2011;34(1):247-248, and Diabetes Care. 2010;33(9):2129-2131]. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation [published corrections appear in Diabetes Care. 2011;34(1):247–248, and Diabetes Care. 2010;33(9):2129–2131].