Low dose aspirin beyond coronary artery disease: a structured narrative review

Abstract

During the past decades, several innovations in the antiplatelet field were established; including its role in the primary and secondary prevention of atherosclerotic cardiovascular diseases (ASCVD), the development of newer efficient and more safe antiplatelet drugs, moreover, evidence has also accrued on its therapeutic potential that may extend beyond cardiovascular applications, with implications for broader population health and nutrition strategies. This possible role of low-dose aspirin (LDA) has changed the future of aspirin use. This structured narrative review explores the evolving role of LDA in the different fields of medicine beyond cardiovascular indications, including nephrology/vascular access, endocrinology/metabolic disorders, oncology, obstetrics, neurology, gastroenterology/hepatology, rheumatology, respiratory medicine, geriatrics/polypharmacy, and primary care/health systems. The review will also offer a clinical perspective on aspirin’s mechanism of action beyond the antiplatelet effects, anti-inflammatory pathways, and novel mechanisms. It aims to synthesize current evidence, assess the relevance of aspirin as a low-cost, scalable intervention within diverse populations and critically evaluate recent guideline changes regarding primary prevention. We searched PubMed, Embase, Cochrane Library, Web of Science, and Scopus (inception to January 2025) for studies on LDA beyond cardiovascular disease to identify studies, reviews, and guidelines related to LDA use in non- coronary artery disease (non-CAD) populations. Emphasis was placed on epidemiological findings, clinical trials, and public health perspectives that intersect with nutritional status, chronic disease risk, and health equity. Findings highlight the strong recommendations of LDA in reducing preeclampsia risk in high-risk pregnant women. For the phosphatidylinositol 3-kinase catalytic subunit alpha (PIK3CA) mutated stage II-III colon cancer, LDA lowered recurrence risk by nearly 50%. High-risk antiphospholipid syndrome (APS) patients showed significant thrombosis reduction. Many other medical conditions need shared decision making; however, major bleeding risk increased 1.5–2.0-fold, with additional risk of intracranial hemorrhage, particularly in adults > 70 years. LDA holds a promise as a multifaceted agent in preventive health beyond CAD. Its potential applications warrant further investigation, particularly in high-risk groups.