Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease: Shared Decision Making in Clinical Practice

Clinical decision making regarding the appropriate use of aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) events is a complex process that requires assessment of the benefits and risks for each patient. Critically important elements of the process include evaluation of the patient’s absolute risk of ASCVD (the primary determinant of potential benefit from aspirin), the patient’s absolute risk of bleeding (the primary determinant of potential risk), and the patient’s willingness to undergo long-term therapy.¹ Despite numerous general guidelines on the use of aspirin for primary prevention, there is limited formal guidance in making these parallel assessments of benefit and risk or in using this information to identify appropriate patients for treatment. Inappropriate use of aspirin for primary prevention is common in clinical practice,² highlighting the important need for improving evidence-based decision making about aspirin use and for providing tools to facilitate this benefit/risk assessment.