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Filippo Cademartiri: What Happened When Guidelines Shifted Against Aspirin for Primary Cardiovascular Prevention
Filippo Cademartiri/LinkedIn
Feb 5, 2026, 08:29

Filippo Cademartiri: What Happened When Guidelines Shifted Against Aspirin for Primary Cardiovascular Prevention

Filippo Cademartiri, Consultant Advanced Cardiovascular Imaging at UPMC Salvator Mundi International Hospital, posted on LinkedIn about a recent article by Stephanea Roeser et al, published in American Journal of Preventive Cardiology:

”Aspirin use is declining – but not always for the right reasons

This 2025 population-based study examines what happened when guidelines shifted against aspirin for primary cardiovascular prevention – and how people actually responded in real life.

What the study did

Researchers conducted three large telephone surveys (2015, 2017, 2019–2020) across five U.S. states, including 8,197 adults without prior cardiovascular disease. The goal: track aspirin use, cessation, and reasons for stoppingduring a period of changing evidence and guidelines.

Key trends

Aspirin use for primary prevention was:

39% in 2015
41% in 2017
decreased 34% in 2019–20
The proportion of people stopping aspirin rose from 14–15% to 22%

So yes – use declined, but slowly and incompletely.

Why did people stop?

Among those who quit:

  • Doctor’s advice was the leading reason (38% by 2019–20)
  • Negative media coverage surged dramatically (from 4% to 29%)
  • Bleeding, side effects, or ‘doesn’t work’ were less common drivers

Notably, guidelines alone had little immediate impact. The biggest behavioral shift followed high-profile media coverage of aspirin trials – not the 2016 USPSTF recommendations.

The hidden problem

Despite updated evidence:

  • One-third of older adults still use aspirin for primary prevention
  • Many self-prescribe, enabled by low cost and easy access
  • Fewer than half ever discussed aspirin with a clinician

Meanwhile, abrupt aspirin discontinuation may increase short-term CV risk, a nuance often lost in public messaging.

Bottom line

Guidelines don’t change practice on their own.

Clinician conversations matter more than headlines.

The aspirin story isn’t just about evidence – it’s about how evidence is communicated, interpreted, and acted upon.”

Title: Population cessation of aspirin use for the prevention of cardiovascular disease

Authors: Stephanea Roeser, Sue Duval, Russell V. Luepker, Milton Eder, John R. Finnegan, Jeremy R. Van’t Hof

Read the Full Article on American Journal of Preventive Cardiology

Filippo Cademartiri: What Happened When Guidelines Shifted Against Aspirin for Primary Cardiovascular Prevention

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Aspirin Cardiology Cardiovascular Disease CVD Filippo Cademartiri Headlines Health Hematology Hemostasis Hemostasis Today Jeremy R. Van't Hof John R. Finnegan Medicine Milton Eder Russell V. Luepker Stephanea Roeser Sue Duval thrombosis UPMC Salvator Mundi International Hospital
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