Acetylsalicylic Acid and the Primary Prevention of Cardiovascular Disease (1991)

Given the available information there is no clear evidence that routine use of ASA in symptomatic men leads to a reduction in the rates of death from all causes, from cardiovascular disease or from myocardial infarction (when suddenly deaths are taken into account). The benefit of ASA therapy observed in the decreased incidence of myocardial infarction needs to be balanced against the potential adverse effects, particularly disabling stroke, that may be related to hemorrhagic properties of ASA.
There is no evidence from the U.S. Aspirin trial to indicate that ASA therapy is particularly effective in reducing the incidence of myocardial infarction among asymptomatic people who may have risk factors for ischemic heart disease (i.e., smoking, hypertension, or a family history of myocardial infarction).
The evidence is not strong enough to support a recommendation that routine ASA therapy be used or not used for the primary prevention of cardiovascular disease in asymptomatic men. The decision on whether to prescribe ASA should be made on an individual basis after the benefits of decreased risk of ischemic cardiovascular events have been balanced against the potential risk associated with prolonged ASA use.