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Aspirin primary prevention — ABIM Board MCQ

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EasyGeneral Internal MedicineAspirin primary preventionABIM Board

A 64-year-old man with hypertension asks whether he should start aspirin to prevent a first myocardial infarction. He has no history of atherosclerotic cardiovascular disease or diabetes. Two years ago, he was hospitalized for bleeding from a peptic ulcer. Which of the following is the most appropriate recommendation?

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Correct answer: A — Do not initiate aspirin for primary prevention

The correct answer is A. The USPSTF recommends against initiating aspirin for primary prevention of cardiovascular disease in adults aged 60 years or older because the bleeding harms outweigh the small cardiovascular benefit. This patient also has a major bleeding-risk factor: prior peptic ulcer hemorrhage. Older age is not an indication for aspirin; it increases bleeding risk, making A incorrect. Clopidogrel is not an alternative antiplatelet agent for routine primary prevention, so C is inappropriate. Aspirin and statins are not interchangeable; statin eligibility should be assessed separately using cardiovascular risk, making D incorrect. Proton pump inhibitor therapy may reduce upper gastrointestinal injury but does not create a primary-prevention indication for aspirin or eliminate its overall bleeding risk, so E is also incorrect.

Reference: US Preventive Services Task Force. Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication. Final Recommendation Statement, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/aspirin-to-prevent-cardiovascular-disease-preventive-medication