[Should individuals without evidence of coronary disease and with risk factors receive continuous treatment with aspirin? Arguments against].

There is a widespread opinion, above the non-scientific press, of the fact that it is demonstrated the aspirin usefulness in the primary prevention of the ischemic heart disease. This feeling is based on the results of the Physicians' Health Study. This wrong position is stablished on the significant reduction of the risk of myocardial infarction, since even though this study demonstrated a very significant, but there were also a non significant excess of hemorrhagic strokes and of sudden death among the physicians on aspirin treatment. For this reason the Physicians' Health Study demonstrated no effect on the cardiovascular mortality neither on the total mortality, that was the main objective of this study. On the other hand, all the primary prevention trials employing aspirin, have demonstrated also a significant excess of gastrointestinal bleeding complications. While is unquestionable the beneficial effect of the aspirin in the secondary prevention of patients with previous ischemic heart disease, the complications that aspirin may produce with its employment in healthy subjects, counterbalance the possible beneficial effect of the reduction of the incidence of myocardial infarction in a low-risk population. There are several ongoing trials, yet not concluded, that attempt to determine the usefulness of aspirin in primary prevention in high risk populations in order to clarify if there is a place in the employment of the aspirin in the primary prevention of ischemic heart disease.