What is the rationale for the lower COR for prophylactic aspirin in the present guideline?
The rationale for the lower COR for prophylactic aspirin in the present guideline is based on the post hoc study of older trials which suggest that the benefit risk ratio for prophylactic aspirin generally becomes more favorable at >10% estimated ASCVD risk. Similarly, in more recent trials, the estimated ASCVD risk has generally exceeded the actual risk observed during these trials, which has led to the removal of a specific PCE risk threshold as an inclusion criterion for aspirin consideration. These changes reflect the need to instead consider the totality of available clinical statements and guidelines evidence for ASCVD risk and to also tailor decisions about prophylactic aspirin to patient and clinician preferences.