A new analysis suggests that using a newer cardiovascular risk model could dramatically shrink the number of middle-aged adults who should consider aspirin for heart disease prevention. The study, which applied the Predicting Risk of Cardiovascular Disease EVENTS (PREVENT) equations to a national sample, found that far fewer people would be eligible for aspirin than when using older risk calculators. In the United States, among adults aged 40 to 59 without cardiovascular disease, 8.3% were identified as aspirin candidates under the traditional pooled cohort equations, but only 1.2% qualified under PREVENT. Among those who met the older criteria, nearly nine in ten would not meet PREVENT’s threshold, and of the roughly 7.6 million adults who reported taking aspirin for prevention, about 97% did not meet PREVENT’s eligibility.
These findings arrive as clinicians weigh the delicate balance between aspirin’s potential to reduce cardiovascular events and its well-established risk of major bleeding. The U.S. preventive guidelines have long recommended considering aspirin for certain adults aged 40 to 59 who are not at high bleeding risk and who carry a 10-year cardiovascular risk of at least 10%, calculated with traditional risk models. The new analysis implies that adopting PREVENT could meaningfully shrink the pool of people for whom aspirin is advised, prompting urgent questions about how best to set thresholds for benefit in primary prevention.
The study analyzed data from the National Health and Nutrition Examination Survey collected between 2015 and 2020, encompassing 3,158 participants who mirror roughly 59.4 million Americans aged 40 to 59 without cardiovascular disease. The researchers excluded individuals with conditions that would elevate bleeding risk—such as severe kidney disease, elevated urinary albumin, low platelet counts, cancer, heart failure, or those taking medications that increase bleeding risk—and then calculated each person’s 10-year cardiovascular risk with both the pooled cohort equations and PREVENT. Aspirin candidacy was defined as a 10-year risk of 10% or higher. The contrast between risk calculators was stark: 8.3% qualified under the traditional method, but only 1.2% did so under PREVENT. Among those who met pooled cohort criteria, 85.9% did not meet PREVENT’s threshold. And among an estimated 7.6 million adults who reported aspirin use for prevention, nearly all—about 97%—fell below PREVENT’s eligibility.
The authors emphasize that adopting PREVENT would raise urgent questions about whether the same 10% cutoff used with older calculators should apply to a newer, better-calibrated tool. If PREVENT-like thresholds are used, determining the net benefit of aspirin will require dedicated modeling studies that weigh the reduction in heart attacks and strokes against the risk of major bleeding and other adverse effects. The researchers also note that most adults who reported aspirin use for prevention did not meet either calculator’s criteria, pointing to a substantial opportunity to discontinue therapy where expected benefit is unlikely.
For Thai readers, the implications are clear and timely. Thailand faces the same fundamental questions that prompted the US discussion: who should receive aspirin for primary prevention, and how do we balance potential cardiovascular benefits against the harm of bleeding? Thai guidelines currently rely on established risk assessment tools to guide preventive therapies, but as global research evolves, there is a need to re-examine these tools in the Thai context. The PREVENT approach underscores the potential value of calibrating risk tools to reflect broader and more accurate risk estimates in diverse populations. Without localized modeling, health professionals in Thailand might either over-treat individuals unlikely to benefit or under-treat those at meaningful risk.
In Thailand, where family health decisions are often a collective affair and physicians hold respected roles in guiding care, the communication of risk becomes essential. Thai families frequently consult elders and rely on trusted clinicians for advice. The new findings present an opportunity to reframe conversations about prevention in a culturally sensitive way: explaining that a “one-size-fits-all” threshold may no longer be appropriate, and that decisions should be individualized, transparent about bleeding risks, and grounded in the most accurate risk estimates available. This aligns with Buddhist principles emphasizing informed choice, non-harm, and the balance of benefits and harms in daily life decisions.
From a public health perspective, adopting PREVENT-like risk assessment could influence not only prescribing patterns but also public messaging and health education. In Thailand, where lifestyle factors such as diet, physical activity, and smoking cessation play pivotal roles in cardiovascular risk, risk-calibrated strategies could empower patients to focus on proven prevention methods. Medical communities might prioritize shared decision-making that respects patients’ values and preferences, while integrating bleeding risk assessment—gastrointestinal protection strategies, for instance—and ensuring that prescription decisions are revisited as risk profiles change over time.
This evolving landscape also offers a broader lens on how Thai health systems approach preventive care. Historically, Thailand has championed primary prevention through public health campaigns and accessible primary care, yet resource constraints and regional disparities remain. A more precise risk stratification model could help allocate preventive therapies more efficiently, directing attention to those most likely to benefit while reducing exposure for those at low risk. Translating the PREVENT framework into Thai clinical practice would require validation studies in local populations, followed by training for clinicians on interpreting refined risk scores, discussing benefits and harms with patients, and aligning recommendations with available medications and monitoring capabilities.
Beyond policy, the new findings invite a reexamination of patient education materials and clinical practice guidelines. Clear, culturally resonant explanations of risk, bleeding potential, and the rationale for or against aspirin can help families make informed choices. Schools and community health centers could incorporate risk literacy into health education, empowering adults to engage in constructive dialogue with doctors and family members. The Thai healthcare system could leverage this momentum to promote healthier lifestyles that reduce cardiovascular risk overall—such as improved nutrition, regular physical activity, and smoking cessation—thereby complementing any future aspirin guidelines with comprehensive prevention strategies.
Looking ahead, researchers in Thailand and globally will need to conduct modeling studies that adapt PREVENT-like risk calculations to local demographics and disease patterns. This work will determine whether regional thresholds for aspirin are appropriate or whether different cutoffs are needed to maximize net benefit in Thai populations. In the meantime, clinicians are encouraged to exercise caution in prescribing aspirin for primary prevention, particularly for patients with any bleeding risk factors or those unlikely to experience meaningful cardiovascular risk reduction. Patients should be engaged in shared decision-making conversations that consider personal preferences, potential harms, and alternatives such as lifestyle interventions or statin therapy where appropriate.
For Thai families facing health decisions, the takeaway is practical and immediate. If you or a loved one are being considered for aspirin therapy as a preventive measure, ask your clinician how your individual risk is calculated and what the potential benefits and harms mean for you. Discuss whether newer risk assessments, when available and validated locally, would change the recommendation. And remember that prevention is a multidimensional pursuit: maintaining a healthy weight, staying physically active, eating a balanced diet rich in fruits and vegetables, avoiding tobacco, and managing blood pressure and cholesterol remain foundational. The latest research invites a thoughtful reevaluation of aspirin for primary prevention, with a focus on personalized risk, patient values, and a cautious approach that prioritizes real-world benefits over theoretical gains.
In sum, the study’s key message is not that aspirin is never useful, but that many middle-aged adults may not be good candidates under newer risk assessment methods. The path forward for Thailand—and for health systems worldwide—lies in robust validation of refined risk tools for local populations, informed and collaborative decision-making with patients, and a renewed emphasis on holistic, evidence-based prevention strategies that align medical practice with everyday lives and cultural contexts.