Definiton of Appropriate Use of Aspirin
The appropriate use of aspirin was evaluated according to the USPTF and ESC guidelines in the primary prevention group. The ESC guidelines do not recommend aspirin for primary prevention (6). The USPTF guidelines suggest aspirin for adults age 40 to 70 at higher risk of atherosclerotic CVD without higher bleeding risk (8). Therefore, we defined aspirin use as inappropriate for all patients according to the ESC guidelines and for patients younger than 40, elder than 70, ASCVD score < 10% and, in those at high bleeding risk according to the USPTF guidelines.