{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:03:23Z","timestamp":1784106203869,"version":"3.55.0"},"reference-count":113,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T00:00:00Z","timestamp":1721088000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Based on a wealth of evidence, aspirin is one of the cornerstones of secondary prevention of cardiovascular disease. However, despite several studies showing efficacy also in primary prevention, an unopposed excess risk of bleeding leading to a very thin safety margin is evident in subjects without a clear acute cardiovascular event. Overall, the variability in recommendations from different scientific societies for aspirin use in primary prevention is a classic example of failure of simple risk stratification models based on competing risks (atherothrombosis vs. bleeding), perceived to be opposed but intertwined at the pathophysiological level. Notably, cardiovascular risk is dynamic in nature and cannot be accurately captured by scores, which do not always consider risk enhancers. Furthermore, the widespread use of other potent medications in primary prevention, such as lipid-lowering and anti-hypertensive drugs, might be reducing the benefit of aspirin in recent trials. Some authors, drawing from specific pathophysiological data, have suggested that specific subgroups might benefit more from aspirin. This includes patients with diabetes and those with obesity; sex-based differences are considered as well. Moreover, molecular analysis of platelet reactivity has been proposed. A beneficial effect of aspirin has also been demonstrated for the prevention of cancer, especially colorectal. This review explores evidence and controversies concerning the use of aspirin in primary prevention, considering new perspectives in order to provide a comprehensive individualized approach.<\/jats:p>","DOI":"10.3390\/jcm13144148","type":"journal-article","created":{"date-parts":[[2024,7,16]],"date-time":"2024-07-16T11:31:57Z","timestamp":1721129517000},"page":"4148","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Aspirin in Primary Prevention: Looking for Those Who Enjoy It"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4146-7099","authenticated-orcid":false,"given":"Roberta","family":"Della Bona","sequence":"first","affiliation":[{"name":"Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1915-585X","authenticated-orcid":false,"given":"Simona","family":"Giubilato","sequence":"additional","affiliation":[{"name":"Cardiology Department, Cannizzaro Hospital, 95126 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5547-306X","authenticated-orcid":false,"given":"Marco","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Di.M.I.), University of Genova, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9669-4278","authenticated-orcid":false,"given":"Stefano","family":"Benenati","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Di.M.I.), University of Genova, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Rossini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emergency Department and Critical Areas, Azienda Ospedaliera Santa Croce e Carle, 12100 Cuneo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8586-9930","authenticated-orcid":false,"given":"Stefania Angela","family":"Di Fusco","sequence":"additional","affiliation":[{"name":"Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Novarese","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine (Di.M.I.), University of Genova, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7069-4015","authenticated-orcid":false,"given":"Giuseppe","family":"Mascia","sequence":"additional","affiliation":[{"name":"Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicola","family":"Gasparetto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, AULSS2 Marca Trevigiana, Ca\u2019 Foncello Hospital, 31100 Treviso, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1297-2056","authenticated-orcid":false,"given":"Antonio","family":"Di Monaco","sequence":"additional","affiliation":[{"name":"Department of Cardiology, General Regional Hospital \u201cF. Miulli\u201d, Acquaviva delle Fonti, 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Gatto","sequence":"additional","affiliation":[{"name":"Cardiology Department, San Giovanni Addolorata Hospital, 00184 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filippo","family":"Zilio","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Santa Chiara Hospital, APSS, 2, Largo Medaglie d\u2019Oro, 38123 Trento, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlotta","family":"Sorini Dini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Borrello","sequence":"additional","affiliation":[{"name":"Division of Cardiology and Intensive Care Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0092-8717","authenticated-orcid":false,"given":"Giovanna","family":"Geraci","sequence":"additional","affiliation":[{"name":"Cardiology Unit, S. Antonio Abate Hospital, ASP Trapani, 91016 Erice, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"Riccio","sequence":"additional","affiliation":[{"name":"Cardiovascular Department, Sant\u2019Anna e San Sebastiano Hospital, 81100 Caserta, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"De Luca","sequence":"additional","affiliation":[{"name":"Division of Cardiology\u2014Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7187-2234","authenticated-orcid":false,"given":"Furio","family":"Colivicchi","sequence":"additional","affiliation":[{"name":"Cardiology Department, San Filippo Neri Hospital, ASL Roma 1, 00135 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9347-8884","authenticated-orcid":false,"given":"Massimo","family":"Grimaldi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, General Regional Hospital \u201cF. Miulli\u201d, Acquaviva delle Fonti, 70021 Bari, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele Massimo","family":"Giulizia","sequence":"additional","affiliation":[{"name":"Cardiology Department, Garibaldi Nesima Hospital, 95122 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9854-5046","authenticated-orcid":false,"given":"Italo","family":"Porto","sequence":"additional","affiliation":[{"name":"Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy"},{"name":"Department of Internal Medicine (Di.M.I.), University of Genova, 16132 Genoa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabrizio Giovanni","family":"Oliva","sequence":"additional","affiliation":[{"name":"\u201cA. 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