Aspirin in Primary Prevention

Which woman should use it?

Abstract

The use of aspirin in the primary prevention of cardiovascular disease (CVD) in women represents one of the most complex debates in contemporary cardiovascular medicine.
Unlike its well-established efficacy in secondary prevention, the benefit of aspirin in preventing a first cardiovascular event in asymptomatic women must be carefully assessed, taking into account the balance between reducing cerebrovascular risk and increasing hemorrhagic risk. This review analyzes the most recent evidence on aspirin use in women without established CVD, examining data from randomized controlled trials, meta-analyses, updated consensus guidelines, and female-specific risk factors that may influence clinical decision-making. Routine low-dose aspirin for primary prevention in asymptomatic women is not universally recommended. Benefits (mainly ischemic stroke reduction in some women) are small and frequently offset by an increased risk of major bleeding; current guidance favors individualized decisions based on age, estimated atherosclerotic cardiovascular disease (ASCVD) risk, and bleeding risk