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Aspirin in Primary Prevention — EECC MCQ

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ModerateHypertension & Preventive CardiologyAspirin in Primary PreventionEECC

A 62-year-old man with type 2 diabetes and hypertension but no established CVD asks whether he should take aspirin for primary prevention. His SCORE2-Diabetes risk is 12%. What is the current ESC recommendation?

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Correct answer: E — Aspirin for primary prevention is not routinely recommended due to the increased risk of major bleeding, which offsets the modest reduction in ischaemic events

The 2021 ESC Prevention Guidelines recommend against routine use of aspirin for primary prevention of CVD (Class III — not recommended). This is based on the ASCEND (diabetes), ARRIVE, and ASPREE trials which showed that the modest reduction in ischaemic events (MI) was offset by a significant increase in major bleeding (particularly GI and intracranial haemorrhage). The net clinical benefit is unfavourable for most primary prevention patients. Aspirin remains a cornerstone of secondary prevention (established CVD). For primary prevention in very-high-risk patients, the decision should be individualised, but routine use is not supported by current evidence.

Reference: ESC (2021): Guidelines on Cardiovascular Disease Prevention