Table 2 Recommendations for low-dose aspirin therapy in cardiovascular disease primary prevention

American Heart Association/American Stroke Association [78, 79]

a) The use of aspirin for cardiovascular (including but not specific to stroke) prophylaxis is reasonable for people whose risk is sufficiently high (10-year risk >10 %) for the benefits to outweigh the risks associated with treatment.

b) Aspirin can be useful for the prevention of a first stroke among women, including those with diabetes mellitus, whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment.

c) Aspirin might be considered for the prevention of a first stroke in people with chronic kidney disease (ie, estimated glomerular filtration rate <45 mL/min/1.73 m²). This recommendation does not apply to severe kidney disease (stage 4 or 5; estimated glomerular filtration rate <30 mL/min/1.73 m²).

d) Aspirin is not useful for preventing a first stroke in low-risk individuals with or without diabetes.

e) Use of aspirin for primary cardiovascular prevention is reasonable in diabetic patients whose 10-year risk of events is > 10 % (men age > 50 years and women age > 60 years with at least 1 additional risk factor: smoking, hypertension, dyslipidemia, albuminuria, or family history of premature cardiovascular events) and who are not at increased risk of bleeding (no history of gastrointestinal bleeding or peptic ulcer disease, no concurrent use of other medications that increase bleeding risk).

f) Aspirin may be considered for diabetes patients at intermediate risk of cardiovascular events (younger patients with at least 1 risk factor, older patients with no risk factors, or patients with a 10-year risk of 5 to 10 %)

American College of Chest Physicians [32, 80]

Aspirin is recommended for the primary prevention of cardiovascular events in all patients aged 50 years or older with or without symptomatic cardiovascular disease.

Canadian Cardiovascular Society [81]

Aspirin is not recommended in men or women without evidence of manifest vascular disease.

European Society of Cardiology [82]

Aspirin is not recommended in individuals without cardiovascular or cerebrovascular disease.