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Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease Shared Decision Making in Clinical Practice

Samia Mora, MD, MHS1,2; Jeffrey M. Ames, BS, MEng3; JoAnn E. Manson, MD, DrPH1,4
[+] Author Affiliations
1Division of Preventive Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
2Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
3Software and Mobile Application Development, Boston, Massachusetts
4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
JAMA. 2016;316(7):709-710. doi:10.1001/jama.2016.8362.
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This Viewpoint discusses the challenges clinicians face individualizing decisions for patients about the benefits and risks of using aspirin for primary prevention of cardiovascular disease.

Clinical decision making regarding the appropriate use of aspirin for the primary prevention of atherosclerotic cardiovascular disease (ASCVD) events is a complex process that requires assessment of the benefits and risks for each patient. Critically important elements of the process include evaluation of the patient’s absolute risk of ASCVD (the primary determinant of potential benefit from aspirin), the patient’s absolute risk of bleeding (the primary determinant of potential risk), and the patient’s willingness to undergo long-term therapy.1 Despite numerous general guidelines on the use of aspirin for primary prevention, there is limited formal guidance in making these parallel assessments of benefit and risk or in using this information to identify appropriate patients for treatment. Inappropriate use of aspirin for primary prevention is common in clinical practice,2 highlighting the important need for improving evidence-based decision making about aspirin use and for providing tools to facilitate this benefit/risk assessment.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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