Synopsis

Source of validity: Scientific
Rating (out of 5): 5

Acetylsalicylic acid (aspirin) is supported by strong scientific evidence for use in the prevention and treatment of certain cardiovascular diseases (CVD), particularly in secondary prevention. Aspirin irreversibly inhibits cyclooxygenase-1 (COX-1), reducing the synthesis of thromboxane A2, a potent promoter of platelet aggregation. By decreasing platelet aggregation, aspirin reduces the risk of arterial thrombosis, which is a major cause of myocardial infarction (heart attack) and ischemic stroke.

Large-scale randomized controlled trials, such as the Antithrombotic Trialists’ Collaboration meta-analyses, have demonstrated that daily low-dose aspirin significantly reduces the risk of recurrent myocardial infarction, stroke, and vascular death in patients with established cardiovascular disease. Guidelines from the American Heart Association and European Society of Cardiology recommend aspirin for secondary prevention in most patients with prior cardiovascular events.

However, the use of aspirin for primary prevention (i.e., in people without established CVD) is more controversial, with recent studies showing only modest benefit and increased risk of bleeding. The current consensus supports its use mainly for secondary prevention and in selected high-risk primary prevention cases where benefits outweigh bleeding risks.

In summary, acetylsalicylic acid’s role in CVD is supported by robust scientific data, especially for secondary prevention, making it a cornerstone therapy in cardiovascular medicine.

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