Low-dose aspirin in the primary prevention of cardiovascular disease: how to balance the benefits and the risks.

The favorable clinical experience with aspirin in the secondary prevention of cardiovascular disease, which has now clearly established the indications for the use of the drug in this context, has been the driving force behind the extension of its use to primary prevention. Here, however, the balance between the benefits and risks is substantially different from that of secondary prevention. In view of this, health authorities have been more reluctant to approve the generalized use of aspirin in primary prevention. We will here review the reasoning which should be at the basis of a set of recommendations, as recently expressed by two American expert opinion panels.