title: Aspirin therapy in primary cardiovascular disease prevention: a position paper of the European Society of Cardiology working group on thrombosis.
abstract: Although the use of oral anticoagulants (vitamin K antagonists) has been abandoned in primary cardiovascular prevention due to lack of a favorable benefit-to-risk ratio, the indications for aspirin use in this setting continue to be a source of major debate, with major international guidelines providing conflicting recommendations. Here, we review the evidence in favor and against aspirin therapy in primary prevention based on the evidence accumulated so far, including recent data linking aspirin with cancer protection. While awaiting the results of several ongoing studies, we argue for a pragmatic approach to using low-dose aspirin in primary cardiovascular prevention and suggest its use in patients at high cardiovascular risk, defined as ≥2 major cardiovascular events (death, myocardial infarction, or stroke) projected per 100 person-years, who are not at increased risk of bleeding.
authors.affiliation: Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway.
authors.forename: Sigrun
authors.initials: S
authors.lastname: Halvorsen
authors.affiliation: Department of Cardiovascular Science, Catholic University, Rome, Italy.
authors.forename: Felicita
authors.initials: F
authors.lastname: Andreotti
authors.affiliation: Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.
authors.forename: Jurriën M
authors.initials: JM
authors.lastname: ten Berg
authors.affiliation: Medicina 3, Ospedale San Paolo, Dipartimento di Scienze della Salute, Università degli Studi di Milano, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Cattaneo
authors.affiliation: Department of Cardiovascular Disease, University of Bologna, Italy.
authors.forename: Sergio
authors.initials: S
authors.lastname: Coccheri
authors.affiliation: Consorzio Mario Negri, Sud Mozzagrogna Chieti, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Marchioli
authors.affiliation: Santo Andrés Hospital, Leiria, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Morais
authors.affiliation: Department of Cardiology, Heartcenter, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands.
authors.forename: Freek W A
authors.initials: FW
authors.lastname: Verheugt
authors.affiliation: Institute of Cardiology, "G. D'Annunzio" University, Chieti, Italy. Electronic address: rdecater@unich.it.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
mesh_terms: D001241:Aspirin / Q000008:administration & dosage*; D002309:Cardiology / Q000592:standards* / Q000639:trends; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D011322:Primary Prevention / Q000592:standards* / Q000639:trends; D012955:Societies, Medical / Q000592:standards* / Q000639:trends; D013927:Thrombosis / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D001241:Aspirin
keywords: aspirin; bleeding; cancer; death; myocardial infarction; primary prevention