In which individuals should aspirin be used for primary prevention of cardiovascular disease?

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EVIDENCE-BASED ANSWERIn patients older than 40 years without cardiovascular disease (CVD), aspirin use decreases the risk of nonfatal myocardial infarction (MI) by 22% and allcause mortality by 6%. However, aspirin has no effect on stroke or all-cause mortality and may increase the risk of hemorrhage and other nontrivial bleeding (SOR: B, meta-analysis of heterogeneous RCTs). Low-dose aspirin should be given to adults 50 to 69 years old with a 10% or higher 10-year risk of CVD who are not at increased risk of bleeding and have a life expectancy of at least 10 years. The decision should be individualized for adults 60 to 69 years old (SOR: C, expert opinion).

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