One trial evaluated the benefit of aspirin in a screened general population cohort with a low ankle-brachial index.891 There was no benefit of aspirin in reducing the rate of fatal or nonfatal coronary events, stroke, or revascularization pro- cedures (HR, 1.03; 95% CI, 0.84 1.27). One meta-analysis evaluated cilostazol versus placebo in 3782, 1187, and 705 patients with peripheral artery disease, cerebrovascular dis- ease, and coronary stenting, respectively.892 The incidence of vascular events was lower in the cilostazol group com- pared with the placebo group (RR, 0.86; 95% CI, 0.74 0.99; P=0.038), including a lower incidence of cerebrovascular increase in serious bleeding complications (RR, 1.00; 95% CI, 0.66 1.51; P=0.996). The primary and secondary prevention populations were not analyzed separately; however, there was no statistical heterogeneity among the trials. In a subgroup analysis of the Hypertension Optimal Treatment (HOT) trial, subjects with renal failure (estimated ) had a reduction in stroke risk with aspirin (HR, 0.21; 95% CI, 0.06 0.75).893 In addition, total mortality was reduced by half (HR, 0.51; 95% CI, 0.27 0.94) and cardiovascular mortality by 64% (HR, 0.36; 95% CI, 0.14 0.90). These results, however, were based on a post hoc analysis. Given the small number of participants with stage 4 or 5 chronic kidney disease (estimated glomerular fil- ) in the HOT trial, the RRs and benefits of aspirin in this population are not known. Antiplatelet Agents and Aspirin: Summary and Gaps Previous guideline statements endorse the use of aspirin for cardiac but not stroke prophylaxis among asymptomatic men whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment.876 These recommenda- tions were based on a reduction of coronary events in men and reduction of stroke in women. 