Which healthy adults should take aspirin?
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In adults with no history of cardiovascular disease, aspirin reduces the risk of nonfatal myocardial infarction (MI). Aspirin prophylaxis does not decrease all-cause mortality, risk of fatal coronary heart disease, or risk of first stroke (strength of recommendation [SOR]: A-, based on multiple randomized controlled trials). The benefits of aspirin use must be weighed against its potential risks, primarily gastrointestinal bleeding and cerebral hemorrhage. The benefit of aspirin increases with higher levels of cardiovascular risk, while the potential for harm remains relatively constant. Adults with a calculated 5-year coronary heart disease (CHD) event risk of 3% or greater should receive prophylaxis (SOR: A, based on multiple randomized controlled trials). The ideal dose of aspirin for prophylaxis is unknown, but it appears that low doses (75-81 mg/d) are as effective as higher doses.