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Although many people take aspirin for primary prevention of adverse cardiovascular (CV) events, previous data suggest that the benefit–harm tradeoff is close. In 2018, three studies that were conducted in patients with no cardiovascular history pushed the pendulum away from primary aspirin prophylaxis. In each trial, a 100-mg daily dose of aspirin was compared with placebo.
ARRIVE involved 12,000 nondiabetic middle-aged and older patients (mean age, 64) with at least two CV risk factors. At 5 years, the incidence of a composite CV endpoint (including myocardial infarction and stroke) was the same in the aspirin and placebo groups (4%), but gastrointestinal bleeding was slightly more common with aspirin (NEJM JW Gen Med Oct 1 2018 and Lancet …