Aspirin may not be as helpful as once thought in preventing first heart attacks

There is no question that aspirin is beneficial after a heart attack or stroke, but there has long been controversy regarding long-term use for primary prevention (preventing a first heart attack or stroke). In May 2104, the Food and Drug Administration (FDA) issued a statement concluding that evidence does not support the use of aspirin in primary prevention.  In Europe, recommendations are that aspirin be considered for primary prevention in people with significant risk (they use a complicated algorithm to predict two or more events per "100 subjective–years").  A recent study in Japan also failed to show that aspirin was helpful in primary prevention in otherwise healthy elderly Japanese men.  The problem with aspirin is not that it lacks benefit in some patients, but rather this benefit must be weighed against the potential harm of bleeding, specifically gastrointestinal bleeding.  If you are taking an aspirin for primary prevention, please consider discussing this with your physician.  There are ongoing studies to help determine who are the "highest risk" individuals that require medication rather than just lifestyle changes.  Identifying calcification in the coronary arteries has been shown to improve risk stratification, and should be considered.

Reference:
Medscape.com. December 11, 2014