A 62-year-old man with blood pressure 128/78 mmHg, no diabetes, and a calculated 10-year cardiovascular risk of 4% asks for daily aspirin to prevent heart attacks. According to current evidence-based guidance, the most appropriate response is:
- A Do not prescribe routine aspirin, because in low-risk individuals the bleeding risk offsets any cardiovascular benefit ✓
- B Prescribe aspirin 75 mg daily, since it prevents both myocardial infarction and stroke
- C Prescribe aspirin only if he also takes a statin concurrently
- D Prescribe aspirin 325 mg daily for five years, then reassess
Correct answer: A. Do not prescribe routine aspirin, because in low-risk individuals the bleeding risk offsets any cardiovascular benefit
Explanation
Major primary prevention trials and subsequent meta-analyses showed that in people at low cardiovascular risk, aspirin produces a small reduction in non-fatal events that is counterbalanced by an increase in major gastrointestinal and intracranial haemorrhage, with no clear reduction in all-cause or cardiovascular mortality. Routine aspirin for primary prevention in such a patient is therefore not advised, unlike its well-established role in secondary prevention after an event.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.