Aspirin For Primary Prevention Of Coronary Artery Disease

Abstract Primary prevention of coronary artery disease (CAD) is an important means to reduce the burden of the disease. Aspirin has been widely prescribed over the last several decades as part of primary CAD prevention strategy. However, three recent hallmark trials - ARRIVE, ASCEND and ASPREE have raised serious question about this common practice. Although, aspirin reduced incidence of non-fatal MI and stroke in the recent studies, bleeding risk was higher. In the present era, where regular exercise, healthy diet, smoking cessation, and statins are used to manage the risk factors of CAD, additional prescription of aspirin seems more harmful than beneficial. The guidelines of major societies such as European Society of Cardiology (ESC), American College of Cardiology (ACC), and American Heart Association (AHA) also reflect this shift. In this article, the authors aim to highlight the current evidence on aspirin use for primary prevention of CAD, in the context of evolving contrasting clinical trial data from the last two decades. We also highlight the pertinent sections of the most recent clinical guidelines of ESC, ACC, and AHA in this article.