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Page 2 of 7 Im et al. Vessel Plus 2018;2:5 I http://dx.doi.org/10.20517/2574-1209.2018.07

INTRODUCTION
Aspirin provides the benefit of primary prevention of vascular events in men or women whose risk for
[1]
myocardial infarction (MI) or ischemic stroke, respectively, is high enough to outweigh the risk for bleeding .
In patients with atherosclerotic vascular disease, long-term antiplatelet therapy reduces the risk of vascular
events. The benefits of long-term antiplatelet therapy substantially exceed the bleeding risk. For primary
prevention of vascular events, aspirin is frequently taken regularly with or without a doctor’s prescription. In
such cases, the balance is less clear because the risks without aspirin and the benefits of aspirin are generally
an order of magnitude lower than in secondary prevention . In a collaborative meta-analysis, the use of
[2-4]
aspirin provided a 12% proportional reduction in serious vascular events, due mainly to a reduction in non-
fatal MI, and the net effect on stroke was not significant . In 2016, the US Preventive Services Task Force
[5]
(USPSTF) updated the recommendations on low-dose aspirin use for primary prevention of cardiovascular
disease (CVD) and colorectal cancer (CRC), based on the American College of Cardiology/American Heart
Association (ACC/AHA) risk calculator . Prevention of CVD events is important, and understanding the
[4]
physician’s recommendations for aspirin use is essential for the management of quality of health care. The
aim of the present study was to assess the 10-year CVD risk and to apply the current recommendations on
aspirin use for primary prevention in Korean participants undergoing a medical check-up.

METHODS
Participants
Between January 2014 and December 2016, the participants who underwent a medical check-up at Sanggye
Paik Hospital Health Promotion Center were enrolled into this study. Adults aged 50 to 69 years were eligible
for the study if they did not have a history of atherosclerotic cardiovascular disease (ASCVD) or stroke with
a low density lipoprotein (LDL)-cholesterol < 190 mg/dL and if they agreed to provide informed consent.
They were classified as having an ASCVD history when they reported a history of MI, coronary bypass, or
angioplasty. The participants’ demographics, vascular risk factors, and medication history were collected at
baseline. The medications taken regularly during the month preceding their visit were recorded. Physical
examination, including blood pressure measurements, electrocardiogram, and blood testing were also
performed.

The 2016 USPSTF recommendations on low-dose aspirin use for primary prevention of CVD and CRC are
as follows: adults aged 50 to 69 years who have ≥ 10% 10-year CVD risk, are willing to take low-dose aspirin
daily and have a life expectancy of at least 10 years, and are not at an increased risk for bleeding. With respect
to adults aged 60 to 69 years, the decision to initiate aspirin use should be an individual one. The evidence
of aspirin use in adults younger than 50 years and aged 70 years or older is insufficient . The 10-year CVD
[4]
risk was calculated using the ASCVD risk estimator (http://tools.acc.org/ASCVD-Risk-Estimator). The risk
factors for the ACC/AHA ASCVD risk calculation were gender, age, race, total cholesterol, high density
lipoprotein (HDL)-cholesterol, diabetes, treatment for hypertension, systolic blood pressure (SBP), and
cigarette smoking. In this study, hypertension was defined as a SBP of at least 140 mmHg or a diastolic blood
pressure (DBP) of at least 90 mmHg. Diabetes mellitus was defined as present if the participant was receiving
hypoglycemic agents or the fasting serum glucose level was 126 mg/dL or higher . Participants who smoked
[6]
regularly during the previous year were classified as current smokers.

High-resolution B-mode ultrasound measurements were performed in some participants according to the
guidelines of the Mannheim intima-media thickness (IMT) Consensus . The methods of IMT measurement
[7]
have been published previously . In brief, a single longitudinal lateral image of bilateral common carotid
[8]
arteries (CCA) was obtained proximal to the carotid bulb, with the patient in the supine position. Automatic
measurements of the CCA-IMT were performed approximately at 10 mm proximal to the carotid bulb. In
this study, mean IMT of both carotid arteries was used for analysis.