Aspirin in the treatment and prevention of cardiovascular disease: current perspectives and future directions.

In secondary prevention among male and female survivors of prior myocardial infarction (MI), occlusive stroke, transient ischemic attack, and other high-risk conditions, long-term use of aspirin confers very similar statistically significant and clinically important reductions in MI, stroke, and cardiovascular death. In men and women suffering acute MI or acute occlusive stroke, aspirin confers similar benefits. In primary prevention, aspirin confers a statistically significant and clinically important reduction in risk of a first MI, but the data on stroke and cardiovascular disease death remain inconclusive, so aspirin should be prescribed on an individual basis by the healthcare provider who weighs this clear benefit against long-term side effects. Worldwide, aspirin used more widely and appropriately would avoid many premature deaths in secondary prevention, during acute MI, and during acute stroke, as well as many first MI in primary prevention.