The rise and fall of aspirin in primary prevention of cardiovascular risk

For many years, aspirin was recommended and prescribed for primary prevention in patients at cardiovascular risk, particularly in those with type 2 diabetes. During this period, guidelines and expert opinions were supported by "recycled" results on non-hierarchical secondary endpoints, subgroups or post-hoc analyses. However, there was no significant difference on the primary efficacy endpoint in these trials AND a significant increase in severe bleeding. In 2018, three placebo-controlled randomized trials were published, all three of which confirmed a negative efficacy/adverse effect balance of aspirin in primary prevention cardiovascular risk patients, with or without diabetes and regardless of their age. Primum non nocere.