Identifying Candidates for Aspirin in Primary Prevention: Men Aged 40-50 with Hypertension, Dyslipidemia, and Familial ASCVD Risk

Premature ASCVD: Why Age 40-50 Males Need Closer Attention? Premature ASCVD is rising sharply in Indian men aged 40-50, demanding earlier intervention. Recent data show that Indian men aged 40-49 years have 3.7 times higher odds of CVD, increasing to 5.7 times in those aged 49–54. (1) Nearly 45% of first MIs in South Asians occur in those aged <55 [53 years in India] (2). This highlights both the underdiagnosis of intermediate CV risk factors and the cumulative risk burden driving early ASCVD in Indian men.

Hypertension, Dyslipidemia, and Family History of CVD: A Dangerous Trio

Hypertension markedly elevates CVD risk—hypertensive adults are over 11 times more likely to develop CVD [OR: 11.58, P<0.01]. (3) Real-world data show that stage 1 hypertension increases the 10-year CV risk by 35% and lifetime risk by 36%. Progression to stage 2 hypertension raises these risks by over 2.5 times [HR: 2.56; 2.29]. (4) Findings from the Framingham Heart Study indicate that having CVD in at least one parent doubled the 8-year CVD risk among men. (5)

The MASHAD study reported a hazard ratio of 2.71 (95% CI: 1.12–6.57; P < 0.05), indicating a 171% higher risk of MI among men with high total cholesterol. (6)

Role of Aspirin: Pathophysiological Rationale

Why does Aspirin continue to be relevant even today in Primary Prevention?

• ASCVD is driven by endothelial dysfunction and a prothrombotic state, where heightened platelet activity promotes thrombosis
• Aspirin’s ability to attenuate platelet-mediated thrombotic events and modulate vascular inflammation supports its consideration in high-risk men, especially where bleeding risk is low. (7)
• In Indian men with clustering of metabolic risk factors, the pro-inflammatory and prothrombotic environment enhances the relevance of antiplatelet strategies like aspirin. (8)

Clinical Case Exemplar

Latest Evidence and Recommendations Supporting Aspirin Use

Takeaway for Clinical Practice

In Indian men aged 40–50 with hypertension, dyslipidemia, and a family history of premature ASCVD, early recognition of the cumulative risk is critical. Evidence supports the consideration of selective low-dose aspirin use for primary prevention when ASCVD risk is high and bleeding risk is low. Decisions should be individualized, integrating guidelines, bleeding risk tools, and lipid and hypertension management.

Abbreviations: Abbreviations: USPSTF; United States Preventive Services Task Force, MI; myocardial infarction, HR; hazard ratio, OR; odds ratio, ESC; European Society of Cardiology, ACC/AHA; American College of Cardiology/ American Heart Association, ASCVD; atherosclerotic cardiovascular disease, DCRM; Diabetes, Cardiorenal, and Metabolic Diseases F/H; family history.