RxCe - Aspirin: Should it Stay or Should it Go? Materials

ASPIRIN: SHOULD IT STAY OR SHOULD IT GO?

Faculty:

Pamela Sardo, PharmD, BS

Pamela Sardo, PharmD, BS, is a freelance medical writer and licensed pharmacist. She is the founder and principal at Sardo Solutions in Texas. Pam received her BS from the University of Connecticut and her PharmD from the University of Rhode Island. Pam’s career spans many years in retail, clinics, hospitals, long-term care, Veterans Affairs, and managed health care responsibilities across a broad range of therapeutic classes and disease states.

Abstract

For decades, pharmacy teams have provided patients with acetylsalicylic acid (ASA), also known as aspirin. It is one of the most prescribed analgesic, antipyretic, and anti-inflammatory agents. It has also been used to reduce the risk of cardiovascular disease (CVD), cardiovascular mortality, and colorectal cancer. However, in recent years, scientists and clinicians have questioned whether the benefits of aspirin use outweigh the risks. The US Preventive Services Task Force (USPSTF) commissioned a systematic review on the effectiveness of aspirin in reducing the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. New guidance from the USPSTF recommends against using low-dose aspirin in patients over 60 for primary prevention of atherosclerotic cardiovascular disease (ASCVD). Low-dose aspirin continues to be recommended for secondary prevention for patients with ASCVD or who have existing heart problems. Safety considerations for patients taking aspirin, as well as patient counseling tips, are also discussed.

Accreditation Statements

In support of improving patient care, RxCe.com LLC is jointly accredited by the Accreditation Council^TM for Continuing Medical Education (ACCME^®), the Accreditation Council for Pharmacy Education (ACPE^®), and the American Nurses Credentialing Center (ANCC^®), to provide continuing education for the healthcare team.

Joint Universal Activity Number: The Joint Accreditation Universal Activity Numbers assigned to this activity are as follows:

Pharmacists: JA4008424-0000-26-144-H01-P

Pharmacy Technicians: JA4008424-0000-26-144-H01-T

Credits: 2 contact hour(s) (0.2 CEU(s)) of continuing education credit.

Credit Types:

Pharmacy - 2 Credits

Type of Activity: Application

Media: Computer-Based Training (i.e., online courses)

Estimated time to complete activity: 2 contact hour(s) (0.2 CEU(s)), including Activity Pre-Test, Post-Test, and Activity Evaluation.

Release Date: July 3, 2026 Expiration Date: February 2, 2027

Target Audience: This educational activity is for Pharmacists and Pharmacy Technicians

How to Earn Credit: From July 3, 2026, through February 2, 2027, participants must:

Read the “learning objectives” and “author and planning team disclosures;”

Take the “Educational Activity Pre-Test;”

Study the section entitled “Educational Activity;” and

Complete the Educational Activity Post-Test and Activity Evaluation. The Educational Activity Post-Test will be graded automatically. Following successful completion of the Educational Activity Post-Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

CE Credits: Credits for this course will be uploaded to CPE Monitor^® for pharmacists and pharmacy technicians.

Statement of Need

Acetylsalicylic acid (ASA), also known as aspirin. It is one of the most prescribed analgesic, antipyretic, and anti-inflammatory agents. Clinicians need to know the benefits and risks of taking aspirin and be able to counsel patients on its use.

Learning Objectives: Upon completion of this educational activity, participants should be able to:

Identify conditions where aspirin is indicated

Review the new recommendations by the US Preventive Services Task Force (USPSTF) on the use of aspirin in cardiovascular disease (CVD) events

Describe patient counseling tips for patients taking aspirin

List safety considerations for patients taking aspirin

Disclosures

The following individuals were involved in planning, developing, and/or authoring this activity: Pamela Sardo, PharmD, BS. None of the individuals involved in developing this activity has a conflict of interest or financial relationships related to the subject matter. There are no financial relationships or commercial or financial support relevant to this activity to report or disclose by RxCe.com or any of the individuals involved in the development of this activity.

Educational Activity Pre-Test

What conditions most accurately identify when aspirin is indicated?

Angina, fever, stomach pain

Fever, pain, osteoarthritis

Angina, fever, Crohn’s Disease

Fever, pain, canker sores

Which statement below from the American College of Cardiology (ACC) and American Heart Association (AHA) is consistent with the new recommendations by the US Preventive Services Task Force (USPSTF) on the use of aspirin?

Aspirin should be used infrequently in the routine primary prevention of ASCVD.

Aspirin should be used weekly as the primary prevention of ASCVD.

Aspirin should never be used for the prevention of ASCVD.

Aspirin should be used twice daily as the primary prevention of ASCVD.

The USPSTF recommends AGAINST using low-dose aspirin

as a primary prevention for the risk of atherosclerotic cardiovascular disease (ASCVD) in patients over 30.

for secondary prevention in patients with ASCVD.

in patients who have existing heart problems.

as a primary prevention for the risk of ASCVD in patients over 60.

Educational Activity

Aspirin: Should it Stay or Should it Go?

Introduction

For decades, aspirin has been prescribed as an analgesic, antipyretic, and anti-inflammatory agent. It has also been used to reduce the risk of cardiovascular disease, cardiovascular mortality, and colorectal cancer. Pharmacy team members have provided aspirin to patients for these purposes for many decades. However, in recent years, scientists and clinicians have questioned whether the benefits of aspirin use outweigh the risks. This course explores current research on this question and the possible future therapeutic uses of aspirin for patients, such as those with liver disease.

Aspirin and Its Uses

Aspirin is one of a group of drugs called non-steroidal anti-inflammatory drugs (NSAIDs). Acetylsalicylic acid (ASA), also known as aspirin, is one of the most prescribed analgesics, antipyretics, and anti-inflammatory agents. Over 17 million prescriptions for aspirin were written in the United States in 2021, and over 40% of the US population aged 40 and older consumes aspirin regularly.^1,2

This discussion is important because aspirin is used for cardiovascular risk reduction, including strokes and myocardial infarctions. Cardiovascular disease (CVD) is the leading cause of mortality in the US, accounting for more than 1 in 4 deaths. Each year, an estimated 605,000 people in the US have a first myocardial infarction, and an estimated 610,000 individuals experience a first stroke.³ Patients also rely on it for coronary conditions, such as angina. Aspirin is indicated and commonly used for fever, pain, and rheumatologic diseases, including osteoarthritis or ankylosing spondylitis.^4,5

The USPSTF’s Review of Aspirin in Cardiovascular Disease

In 2022, the US Preventive Services Task Force (USPSTF) published a review of the effectiveness of aspirin in reducing the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD.³ The review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use.³

Primary prevention of CVD refers to strategies to help prevent heart disease and stroke.³ Secondary prevention of CVD refers to strategies to reduce the risk of a recurrent cardiovascular event in patients who already have CVD.³

The updated USPSTF recommendations replace the USPSTF 2016 statements.³ The recommendations generally align with the 2019 American College of Cardiology (ACC) and American Heart Association (AHA) Guidelines on the Primary Prevention of Cardiovascular Disease.^3,6,7 The ACC and AHA stated that aspirin should be used infrequently in the routine primary prevention of ASCVD.^6,7

The USPSTF recommends against using low-dose aspirin in patients over 60 years of age for the primary prevention of atherosclerotic cardiovascular disease (ASCVD).^3,6 The USPSTF and the ACC recommend low-dose aspirin for secondary prevention for patients with ASCVD or those individuals who have existing heart problems.^3,6 These heart problems can include a history of a heart attack, stroke, or angioplasty.⁶ Angioplasty is also known as percutaneous coronary intervention (PCI). PCI is a treatment that removes plaque buildup and opens blocked arteries. The heart problems may also include coronary artery bypass graft (CABG).⁶ The secondary prevention intervention should be based on the clinician's judgment and long-term antiplatelet strategy.⁶

Key Takeaway:

Updated USPSTF Recommendations on Aspirin in CVD patients:

No, for Primary Prevention

Yes, for Individualized Secondary Prevention

The recommendations are also stratified by age. The recommendations are also stratified by age. For adults aged 40 to 59 with CVD, the decision to initiate low-dose aspirin use as the primary prevention applies to patients who have a 10% or greater 10-year CVD risk and should be made on a case-by-case basis.³ This recommendation was based on evidence of moderate certainty indicating a small net benefit for this patient group relative to the risk of bleeding.³ The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.³ As clinicians review this information, they may note that moderate certainty is weaker than high certainty, and small net benefit is weaker than high net benefit.³

The USPSTF review included 11 randomized trials of low-dose aspirin (100 mg daily or less) in adults aged 40 to 50 and those aged 60 and older. It also stated that “persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily” are more likely to benefit.³ The magnitude of the lifetime benefits is greater when aspirin is initiated at a younger age.³ These USPSTF recommendations on the initiation of aspirin do not apply to patients with a prior history of heart attack, stroke, bypass surgery, or recent stent procedure.⁶

Hypothetical Patient Case

Question:

Which scenario would aspirin treatment most likely confer CV benefit?

A 79-year-old man with hypertension and chronic kidney disease

A 53-year-old man with diabetes and a 10-year ASCVD risk > 12%

Answer:

A 53-year-old man with diabetes and a 10-year ASCVD risk > 12%

Assessment of CVD Risk

Older age is one of the strongest risk factors for CVD.³ Men have a higher overall CVD burden, although women experience higher mortality from certain cardiovascular events, such as stroke.³ Men tend to experience CVD events earlier in life compared with women.³ The burden of CVD also differs by race and ethnicity.⁸ Among both sexes, Black persons have the highest prevalence of CVD.^8,9

The USPSTF, National Heart, Lung, and Blood Institute (NHLBI), European, and Canadian guidelines for the primary prevention of CVD recommend using absolute risk assessment to inform decisions about the intensity of lifestyle and pharmacological preventive interventions.⁹ To date, the ACC/AHA risk estimator is the only US-based CVD risk prediction tool that has published external validation studies in other US-based populations.⁹ Table 1 lists components within the risk estimator.

Table 1

The ASCVD Risk Estimator Components¹⁰

Age	Sex	Race
Systolic Blood Pressure	Diastolic Blood Pressure	Taking Aspirin
Total Cholesterol	HDL Cholesterol	LDL Cholesterol
History of Diabetes	Smoking Question	On a Statin or Antihypertensive Treatment

The estimator has separate equations by sex and by Black and non-Black status.⁷ The equations include the risk factors of age, cholesterol levels, systolic blood pressure level, antihypertension treatment, presence of diabetes, and smoking status.⁹ The equation also focuses on clinical outcomes of myocardial infarction and death from coronary heart disease, ischemic stroke, and stroke-related death.⁹ As mentioned, increasing age and ethnicity heavily influence the ACC/AHA estimated 10-year CVD event risk.⁹

The ACC/AHA primary prevention guidelines recommend the following:⁶

Low-dose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk

Low-dose aspirin 75-100 mg orally daily should not be administered on a routine basis for the primary prevention of ASCVD among adults >70 years of age.

Low-dose aspirin 75-100 mg orally daily should not be administered for the primary prevention of ASCVD among adults of any age who are at increased risk of bleeding.

Point to Ponder:

When a patient comes to the pharmacy counter with an aspirin-containing over-the-counter medication, what would prompt you to ask the patient questions?

The following are key points to remember about the USPSTF report on aspirin for primary prevention:

Aspirin therapy is not one-size-fits-all. While aspirin therapy may benefit some patients, the risk-benefit ratio may not be favorable for others.

Early trials of aspirin use in primary prevention initially showed benefits, including a reduction in the risk of myocardial infarction in the Physicians’ Health Study.¹¹ Subsequent studies, including the Women’s Health Study, identified a reduction in stroke risk.¹²

In 2018, three key trials of primary prevention with aspirin were published.

First, the ASPREE trial found that among healthy older patients (aged ≥65 years), the use of low-dose daily aspirin was associated with increased risk for mortality (5.9% vs. 5.2% for placebo at a median of 4.7 years) and cancer mortality (3.1% vs. 2.3%).¹³ There were similar rates of major bleeding (0.3% in both groups).¹³

Second, the ASCEND trial in patients with diabetes found that the use of daily low-dose aspirin reduced the risk of CVD events more than the use of placebo (8.5% vs. 9.6%, mean 7.4 years of follow-up) but was offset by increased major bleeding risk (4.1% vs. 3.2%).¹⁴

Third, the ARRIVE trial assessed middle-aged and older adults at intermediate risk for ASCVD with and without diabetes. In those without diabetes, the authors found a nonsignificant reduction in ASCVD events (4.29% vs. 4.48%, median five years of follow-up) but a doubling of gastrointestinal bleeding (0.97% vs. 0.46%).¹⁵

The TIPS-3 trial randomized patients at elevated risk for ASCVD to receive aspirin or placebo in addition to a pill containing statin and antihypertensive medications.¹⁶ A significant reduction in CVD events (4.1% vs. 5.8% over a mean of 4.6 years) resulted among patients randomized to receive aspirin.¹⁶

In 2019, the ACC and AHA guidelines recommended that aspirin may harm primary prevention in patients aged ≥70.¹⁷ They also emphasized individual decision-making regarding aspirin use.

Aspirin Patient Counseling Tips

Pharmacists have a vital role in monitoring medication use. Pharmacy technicians are valuable team members who assist patients with over-the-counter medications, process prescriptions, and perform many other tasks. It is important to guide consumers to read the labels on aspirin products they select from store shelves.

It is also important to review the prescription profile for comorbid conditions. Pharmacy professionals should also review the profile to prevent duplicate therapy or drug interactions. People who are allergic to nonsteroidal anti-inflammatory agents, such as ibuprofen, should not take aspirin without speaking to a healthcare professional, as there is cross-reactivity.¹⁸ Patients who have asthma should be cautious about taking aspirin if they have asthma or known bronchospasm associated with NSAIDs.¹⁸ Patients with an allergy to aspirin, uncontrollable blood pressure, severe liver or kidney disease, or bleeding disorders generally should not take aspirin.¹⁸

Patients should also be counseled about bleeding risks associated with chronic heavy alcohol use while taking aspirin. Advise patients to keep all medications out of the reach of children. Educate patients to take aspirin as prescribed, and not to take it more often than directed by the package label or prescription. If indicated, swallow an extended-release aspirin tablet whole with a full glass of water.¹⁹ Do not break, crush, or chew an extended-release formulation.¹⁹

Consult a healthcare provider before using aspirin in late pregnancy. Discontinue aspirin and seek immediate medical help if an allergic reaction occurs.¹⁹ Aspirin may be taken with food to decrease stomach irritation. Patients should be counseled to report red or black, tarry stools or pink or brown urine.¹⁹ Contact a physician if unusual bruising occurs or coughing up blood occurs during aspirin use.¹⁹ These patient counseling tips may be reinforced with auxiliary label placement on prescription containers.

Safety Considerations of Aspirin

Aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) is neither ‘all good’ nor ‘all bad.’²⁰ It may benefit some patients but with a narrow therapeutic window because of the risks of major bleeding, particularly intracranial and gastrointestinal hemorrhage.²⁰ It is important to continue to read medical literature to learn new data as the pendulum is swinging back and forth on aspirin benefits and harms.²⁰

Data suggest that the increased incidence of bleeding associated with aspirin use occurs relatively quickly after initiating aspirin.³ Data do not suggest that aspirin has a different bleeding risk based on age, sex, presence of diabetes, level of CVD risk, or race or ethnicity.³ Although the increase in relative risk does not appear to differ based on age, the USPSTF reported that the absolute incidence of bleeding, and thus, the magnitude of bleeding harm, increased with age, and more so in adults 60 years or older.³

Avoid using aspirin in children with a viral infection. Aspirin is associated with Reye’s syndrome. It has been a cause of lethal poisoning in young children. A clinician may encounter Reye’s syndrome, characterized by vomiting followed by encephalopathy and coagulopathy. Liver failure, with microvesicular fatty infiltration, may also occur in Reye’s syndrome. As aspirin use in children declined in the 1980s, so did the diagnosis of Reye’s syndrome, which has virtually disappeared.²¹

Aspirin may contribute to acid-base balance disturbances.²² Salicylates stimulate the medulla's respiratory center, and patients with salicylate poisoning experience hyperventilation.²² Respiratory paralysis and circulatory collapse secondary to vasomotor depression are possible with toxic doses of aspirin.²²

High doses of aspirin can cause tinnitus. Patients who have inborn coagulopathies, such as hemophilia, should avoid all salicylates. Individuals with a tendency to bleed or bruise easily, as in the setting of dengue or yellow hemorrhagic fever, should avoid the use of aspirin.

Additional Resources

Resource	Topic	Location
Centers for Disease Control and Prevention, Million Hearts^® Initiative	Facilitate impactful collaboration and resource sharing, and promote the implementation of evidence-based strategies to prevent cardiovascular disease	https://millionhearts.hhs.gov/index.html
Centers for Disease Control and Prevention	Preventing Heart Disease	https://www.cdc.gov/heart-disease/prevention/index.html
Mayo Clinic	Daily aspirin therapy: Understand the benefits and risks	https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797

What’s Next?

Research is ongoing in other therapeutic areas for patients with unmet medical needs. In one study, patients with metabolic-associated steatotic liver disease (MASLD, formerly called NAFLD) without cirrhosis took daily low-dose aspirin in a double-blind randomized trial.^23,24 These participants demonstrated reductions in liver fat content over six months compared with similar patients who took a placebo.^23,24 Low-dose aspirin, 81 milligrams daily, decreased liver fat and improved hepatic inflammation and fibrosis markers.^23,24 This use is off-label, and additional studies are needed.

Hypertensive disorders of pregnancy (HDP), such as preeclampsia (PE) and gestational hypertension (gHTN), occur in approximately 15% of pregnant individuals.²⁵ These disorders disproportionately affect self-identified non-Hispanic Black individuals (with the understanding that race is a socially defined construct and the inequity is related to social determinants of health), are increasing in frequency, and are associated with short- and long-term maternal and neonatal morbidities and mortality.²⁵

Preeclampsia is defined as hypertension arising after 20 weeks of gestational age with proteinuria or other signs of end-organ damage.²⁶ Preeclampsia is an important cause of maternal and perinatal morbidity and mortality, particularly with early onset.²⁶ Aspirin at doses below 300 mg selectively and irreversibly inactivates the cyclooxygenase-1 enzyme, suppressing the production of prostaglandins and thromboxane.²⁵ It inhibits inflammation and platelet aggregation. Such an effect has led to the hypothesis that aspirin could be useful for preventing preeclampsia. The Aspirin for Evidence-Based Preeclampsia Prevention trial recently revealed that aspirin at a daily dosage of 150 mg, initiated before 16 weeks gestation, and given at night to a high-risk population reduced the incidence of preterm preeclampsia by 62%.²⁶ A secondary analysis of the Aspirin for Evidence-Based Preeclampsia Prevention trial data also indicated a reduction in the length of stay in the neonatal intensive care unit by 68% compared with placebo.²⁶ This result was attributed mainly to a reduction in births before 32 weeks of gestational age from preeclampsia.²⁶

The ASPIRIN trial is a new, large, pragmatic, comparative effectiveness trial.²⁷ The goal is to test the hypothesis that among at-risk individuals, 162 mg/day aspirin is superior to 81 mg/day in preventing HDP.²⁷

More research is needed to improve the accuracy of CVD risk prediction in all racial, ethnic, and socioeconomic groups. More research is also needed regarding the gastrointestinal bleeding risk associated with aspirin use in populations representative of the US primary CVD prevention population.

Researchers have published that aspirin has been associated with a reduced risk of colorectal cancer and possibly of a few other digestive tract cancers. A recent meta-analysis explained the inverse association between regular aspirin use and the risk of colorectal and other digestive tract cancers. The favorable effect of aspirin increased with longer duration of use and, for colorectal cancer, with increasing dose.²⁸ Aspirin can promote cancer cell death through signaling pathways associated with, or independent of, prostaglandins.²⁹ Prostaglandin-dependent pathways involve COX-2, and prostaglandin-independent pathways involve lymphocytes. CD80 is also involved in immunity. A new study published that metastasis was less frequent, tumor-infiltrating lymphocyte infiltration was higher among aspirin users, and CD80 mRNA expression increased following aspirin treatment.²⁹ More studies are needed to explore the mechanism.

Summary

The USPSTF recommends against initiating aspirin for primary prevention in adults aged 60 years or older. When looking at the lifetime benefit of continuous aspirin use, modeling data suggested little incremental benefit in continuing aspirin use beyond 75 to 80 years. Persons who meet the eligibility criteria for aspirin use at a younger age would have higher CVD risk as they age into their 60s or 70s. This population may benefit more by continuing aspirin use than persons at lower risk.

Interprofessional healthcare team members should ask patients about over-the-counter aspirin or aspirin-containing prescriptions. Aspirin patients should be monitored and counseled to optimize outcomes and prevent adverse effects. All patients should consult their healthcare professional about whether to begin, continue, or safely discontinue aspirin. This decision should be made after carefully reviewing the risks and benefits.

References

Aspirin Drug Usage Statistics, United States, 2013-2021. ClinCalc.Com. 2024. Accessed July 4, 2026. https://clincalc.com/DrugStats/Drugs/Aspirin

Huang WY, Daugherty SE, Shiels MS, et.al. Aspirin Use and Mortality in Two Contemporary US Cohorts. Epidemiology. 2018;29(1):126-133. doi: 10.1097/EDE.0000000000000746

US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et. Al. Aspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;327(16):1577-1584. doi: 10.1001/jama.2022.4983

BAYER- aspirin tablet BAYER ASPIRIN ORIGINAL, CVP HEALTH- aspirin tablet BAYER ASPIRIN ORIGINAL, TRAVEL BASIX- aspirin tablet. Prescribing Information. Lil' Drug Store Products, Inc.. Updated November 27, 2024. Accessed July 4, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=7f5d9ebe-8119-49a2-9380-eca18a5e5e85

Xie Y, Pan M, Gao Y, Zhang L, Ge W, Tang P. Dose-dependent roles of aspirin and other non-steroidal anti-inflammatory drugs in abnormal bone remodeling and skeletal regeneration. Cell Biosci. 2019;9:103. Published 2019 Dec 23. doi:10.1186/s13578-019-0369-9

New USPSTF Recommendation on Aspirin in CVD: No For Primary Prevention, Yes For Secondary Prevention. American College of Cardiology. April 22, 2022. Accessed July 4, 2026. https://www.acc.org/latest-in-cardiology/articles/2022/04/27/20/41/new-uspstf-recommendation-on-aspirin-in-cvd

Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650. doi: 10.1161/CIR.0000000000000725] [published correction appears in Circulation. 2020 Jan 28;141(4):e60. doi: 10.1161/CIR.0000000000000755] [published correction appears in Circulation. 2020 Apr 21;141(16):e774. doi: 10.1161/CIR.0000000000000771]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

Virani SS, Alonso A, Aparicio HJ, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143(8):e254- e743. doi:10.1161/CIR.0000000000000950

Goff DC Jr, Lloyd-Jones DM, Bennett G, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2014;63(25, pt B):2935-2959. doi:10.1016/j.jacc.2013. 11.005

ASCVD Risk Estimator Plus. American College of Cardiology. November 2022. Accessed July 4, 2026. https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/

Steering Committee of the Physicians' Health Study Research Group. Final report on the aspirin component of the ongoing Physicians' Health Study. N Engl J Med. 1989;321(3):129-35. doi: 10.1056/NEJM198907203210301

Bassuk SS, Ridker PM, Manson JE, Buring JE. Aspirin and cardiovascular disease prevention in women: new findings from the Women's Health Study. Women's Health.2005;1:9-10.

McNeil JJ, Nelson MR, Woods RL, et.al. ASPREE Investigator Group. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018;379(16):1519-1528. doi: 10.1056/NEJMoa1803955

ASCEND Study Collaborative Group; Bowman L, Mafham M, Wallendszus K, et.al. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. 2018;379(16):1529-1539. doi: 10.1056/NEJMoa1804988

Capodanno D, Angiolillo DJ. Antithrombotic Therapy for Atherosclerotic Cardiovascular Disease Risk Mitigation in Patients With Coronary Artery Disease and Diabetes Mellitus. Circulation. 2020;142(22):2172-2188. doi: 10.1161/CIRCULATIONAHA.120.045465

Lamy A, Tong W, Joseph P, et.al. The cost implications of a polypill for primary prevention in the TIPS-3 trial. Eur Heart J Qual Care Clin Outcomes. 2022;8(8):899-908. doi: 10.1093/ehjqcco/qcab101

Hira RS, Gosch KL, Kazi DS, et.al. Potential Impact of the 2019 ACC/AHA Guidelines on the Primary Prevention of Cardiovascular Disease Recommendations on the Inappropriate Routine Use of Aspirin and Aspirin Use Without a Recommended Indication for Primary Prevention of Cardiovascular Disease in Cardiology Practices: Insights From the NCDR PINNACLE Registry. Circ Cardiovasc Qual Outcomes. 2022;15(3):e007979. doi: 10.1161/CIRCOUTCOMES.121.007979

Aspirin: Questions and Answers. U.S. Food and Drug Administration. December 18, 2015. Accessed July 4, 2026. https://www.fda.gov/drugs/safe-use-aspirin/aspirin-questions-and-answers#consumers

Aspirin considerations for use. American College of Cardiology. 2012. Accessed July 4, 2026. https://www.acc.org/~/media/Files/Migration%20Content/Quality%20and%20Clinical%20Trials/AFib%20Toolkit/Drugs/Drugs%202/Aspirin.pdf?la=en#:~:text=The%20risk%20to%20gastrointestinal%20bleeding,asthma%20are%20intolerant%20to%20aspirin.&text=Discontinue%20this%20medication%20and%20seek%20immediate%20medical%20help%20if%20allergic%20reaction%20occurs

Lloyd-Jones DM. USPSTF Report on Aspirin for Primary Prevention. JAMA Cardiol. 2022;7(7):667–669. doi:10.1001/jamacardio.2022.0935

Mount M, Toltzis P. 50 Years Ago in The Journal of Pediatrics: Aspirin and Reye Syndrome. J Pediatr. 2020;222:192. doi: 10.1016/j.jpeds.2020.01.039

Goodman Gilman A., Rall T, Nies A, Taylor P, eds. Goodman and Gilman’s The Pharmacological Basis of Therapeutics 8^th ed. Pergamon Press, 1990.

Aspirin for the treatment of nonalcoholic fatty liver disease. Clinicaltrials.gov. May 24, 2024. Accessed July 4, 2026. https://www.clinicaltrials.gov/study/NCT04031729?term=low-dose%20aspirin%20NAFLD&rank=1

Polyzos SA, Chrysavgis L, Vachliotis ID, Chartampilas E, Cholongitas E. Nonalcoholic fatty liver disease and hepatocellular carcinoma: Insights in epidemiology, pathogenesis, imaging, prevention and therapy. Semin Cancer Biol. 2023;93:20-35. doi: 10.1016/j.semcancer.2023.04.010

Effectiveness of Two Aspirin Doses for Prevention of Hypertensive Disorders of Pregnancy: ASPIRIN TRIAL (ASPIRIN) Clinicaltrials.gov. June 21, 2024. Accessed July 4, 2026. https://clinicaltrials.gov/study/NCT06468202?term=Aspirin&aggFilters=status:not rec&rank=1

Rolnik DL, Nicolaides KH, Poon LC. Prevention of preeclampsia with aspirin. Am J Obstet Gynecol. 2022;226(2S):S1108-S1119. doi: 10.1016/j.ajog.2020.08.045

Bosetti C, Santucci C, Gallus S, Martinetti M, La Vecchia C. Aspirin and the risk of colorectal and other digestive tract cancers: an updated meta-analysis through 2019. Ann Oncol. 2020;31(5):558-568. doi: 10.1016/j.annonc.2020.02.012

Simoni O, Scarpa M, Castagliuolo I. et. Al. IMMUNOREACT 7: Regular aspirin use is associated with immune surveillance activation in colorectal cancer. Cancer. 2024;130(13):2272-2286. doi:10.1002/cncr.35297

DISCLAIMER

The information provided in this course is general in nature, and it is designed solely to provide participants with continuing education credit(s). This course and materials are not meant to substitute for the independent, professional judgment of any participant regarding that participant’s professional practice, including but not limited to patient assessment, diagnosis, treatment, and/or health management. Medical and pharmacy practices, rules, and laws vary from state to state, and this course does not cover the laws of each state; therefore, participants must consult the laws of their state as they relate to their professional practice.

Healthcare professionals must consult their employer, healthcare facility, hospital, or other organization for guidelines, protocols, and procedures to follow. The information provided in this course does not replace those guidelines, protocols, and procedures, but is for academic purposes only, and this course’s limited purpose is for the completion of continuing education credits.

Participants are advised and acknowledge that information related to medications, their administration, dosing, contraindications, adverse reactions, interactions, warnings, precautions, or accepted uses is constantly changing. Any person taking this course understands that such a person must make an independent review of medication information before any patient assessment, diagnosis, treatment and/or health management. Any discussion of off-label use of any medication, device, or procedure is informational only, and such uses are not endorsed hereby.

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