ASPIRIN FOR THE PRIMARY PREVENTION OF CARDIOVASCULAR DISEASE: ADVANCES IN DIAGNOSIS AND TREATMENT
Samia Mora, M.D., Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
For the primary prevention of atherosclerotic cardiovascular disease with aspirin therapy, decisions regarding aspirin use should be personalized, balancing the benefit: risk ratio and patient preferences. This presentation will examine advances in cardiovascular and bleeding risk assessment for aspirin use in primary prevention, and review the evidence from a total of eleven randomized clinical trials involving more than 118,000 individuals for the benefits and risks of aspirin use. Recent recommendations will be reviewed, including those of the 2016 U.S. Preventive Services Task Force, regarding the use of low-dose aspirin therapy for the primary prevention of atherosclerotic cardiovascular disease, and secondarily for colorectal cancer prevention. Overall the quality of evidence was high, but important controversies remain unresolved and await several ongoing clinical trials. Individualizing the benefit of aspirin with the risk of bleeding is complex but essential for informed clinical decision making and achieving a net clinical benefit from long-term aspirin therapy for primary prevention. The Aspirin-Guide decision support tool (freely available as an app for mobile devices and also on the web at http://www.aspiringuide.com) is designed to help busy clinicians in shared decision-making discussions with their patients regarding aspirin use for primary prevention.