The efficacy of antiplatelet therapy for the secondary prevention of cardiovascular disease after an
ischemic event is well established. However, the role for antiplatelet therapy for the primary prevention of cardiovascular
disease is more complex because of the interplay of efficacy vs safety in individuals without established
cardiovascular disease who have a relatively low, but linear trajectory of cardiovascular risk. Several large
randomized trials have investigated the efficacy and safety of antiplatelet therapy (primarily aspirin) for patients
without established cardiovascular disease. The pharmacological profile of the most commonly used primary
prevention antiplatelet agent, aspirin, has been delineated by randomized clinical trials and showcased in practice
guidelines for reducing cardiovascular risk. For this indication, aspirin has been consistently shown to reduce the
risk of non-fatal myocardial infarction with little impact on cardiovascular death, but with a consistent increased
risk of bleeding. These divergent results have contributed to differences in the recommendations from international
practice guidelines and highlight controversy at the forefront of considerations for anti-platelet therapy for
primary prevention. However, further studies in specific sub-groups of patients without established cardiovascular
disease such as those with Diabetes Mellitus, chronic kidney disease, or the elderly may clarify which patient
groups will benefit the most from aspirin treatment for the primary prevention of a cardiovascular event.
Keywords: Aspirin, primary prevention, cardiovascular disease, antiplatelet therapy, review, cardiovascular mortality.
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