Aspirin under fire: Aspirin use in the primary prevention of coronary heart disease

The issue of aspirin use in the primary prevention of cardiovascular disease is still debated because of conflicting opinions on risks versus benefits. Recently a United States Food and Drug Administration (FDA) panel rejected the approval of aspirin in the setting of primary prevention in moderate-risk patients. However, the United States Preventive Services Task Force recommends that clinicians discuss aspirin therapy with patients at increased risk for having a future coronary event. During the past 15 years, many large randomized trials have specifically addressed this issue and helped shape the decisions of the FDA panel and the Preventive Services Task Force. These trials lend a handful of experiences and results, with no clear recommendations for antiplatelet therapy in the setting of primary prevention of coronary heart disease (CHD). Recently, trial results have been assimilated into practical tools for risk stratification to guide aspirin use in this setting. An overview and critical evaluation of the work performed thus far is provided in order to lend insight into the ongoing debate and, through use of the Framingham CHD risk prediction score sheets, to better equip practitioners faced with the decision of giving aspirin to "relatively" healthy individuals for CHD primary prevention.