TOPLINE:

Estimates from the Predicting Risk of Cardiovascular Disease EVENT (PREVENT) equations identified substantially fewer individuals eligible to receive aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) than those from pooled cohort equations used in major guidelines.

METHODOLOGY:

• Guidelines recommend aspirin for adults aged 40-59 years not at a high risk for bleeding and with a 10-year risk for ASCVD of at least 10% according to pooled cohort equations. No study has evaluated whether using the more accurately calibrated PREVENT equations would alter the eligibility rates for aspirin.
• Researchers reviewed data from 2015 to 2020 from a survey representing 59.4 million US adults and included 3158 individuals without ASCVD or risk factors for major bleeding (mean age, 49.1 years; 51.9% women).
• They used pooled cohort equations and PREVENT equations to estimate 10-year risk for ASCVD. Individuals with a risk of ≥ 10% were considered eligible to receive aspirin.
• Both equations were used to determine the proportion of individuals who reported taking aspirin for primary prevention despite having a 10-year risk below 10%.

TAKEAWAY:

• Only 1.2% of individuals were found eligible to receive aspirin by PREVENT equations vs 8.3% of them were found eligible by pooled cohort equations.
• Using 10% as the cutoff for the 10-year risk, PREVENT equations found 85.9% of those deemed eligible for aspirin by pooled cohort equations to be ineligible.
• A vast majority (96.9%) of individuals who reported using aspirin for primary prevention did not meet the risk criteria by PREVENT equations.

IN PRACTICE:

“If the same 10% risk threshold is found to identify patients with net benefit from aspirin use when using PREVENT, the current analysis shows that a large proportion of patients in whom aspirin is considered based on the [pooled cohort equations] will no longer be eligible by PREVENT,” the researchers reported.

“There is considerable room to discontinue aspirin in patients who are unlikely to benefit. Updated recommendations tailored to PREVENT-based risk estimates will help accelerate this and ensure that patients among whom aspirin’s net benefit is low or negative are discontinued,” they added.

SOURCE:

This study was led by Ahmed Sayed, MBBS, of Rochester General Hospital in Rochester, New York. It was published online on September 29, 2025, in JAMA Internal Medicine.

LIMITATIONS:

This study relied on self-reported data, thus the researchers could not confirm whether aspirin was used regularly and could not rule out existing cardiovascular disease. The analysis also used data from 2015 to 2020, which was collected before recent updates in the US Preventive Task Force guidelines narrowed the parameters on the use for aspirin for primary prevention.

DISCLOSURES:

No funding source for this study was mentioned explicitly. One author reported receiving grants from Amgen and personal fees from Novo Nordisk and Janssen. Another reported receiving grants from the National Institutes of Health, UK National Institute for Health and Care Research, and US Department of Veterans Affairs.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication