Aspirin has long been a cornerstone of primary prevention of cardiovascular disease. In 2018, three randomized trials updated the literature on aspirin use in the elderly (ASPirin in Reducing Events in the Elderly [ASPREE]), diabetics (A Study of Cardiovascular Events in Diabetes [ASCEND]) and intermediate-risk populations (Aspirin to Reduce Risk of Initial Vascular Events [ARRIVE]).1 Although these trials provided useful insights on contemporary aspirin use, the role of aspirin in primary prevention was contested.