The US Preventive Services Task Force recommends aspirin at a dose of 75 mg/d to prevent MI (but not stroke) in men 45 to 79 years of age and to pre- vent stroke in women 55 to 79 years of age on the basis of their vascular risk and the chances of serious gastrointestinal The US Preventive Services Task Force further notes that the 10-year level of cardiovascular risk for which the benefit exceeds bleeding risk varies from 3% to 11%, depending on age and sex. The most recent AHA guideline for the primary prevention of CVD and stroke also recom- mends aspirin for primary cardiovascular prevention in those with a 10-year coronary heart risk 10%.877 There is no evi- dence that antiplatelet medications reduce the risk of stroke in the general population at low risk.878 880 Although stroke was not analyzed as a separate end point, lack of aspirin use was independently associated with a 16% higher risk of cardiovas- cular events (HR, 1.16; 95% CI, 1.03 1.31) among healthy male physicians 65 years of age.881 The benefit of aspirin for primary prevention of stroke is therefore limited to selected subgroups of patients. Several relevant trials further inform the use of aspirin and other antiplatelet agents for the preven- tion of a first stroke. The Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial randomized 2539 patients with type 2 diabetes mellitus but without a history of atheroscle- rotic disease (including stroke) to either low-dose aspirin (81 or 100 mg/d) or no aspirin.321 The primary outcome was the occur- rence of atherosclerotic events (fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke, and peripheral arterial disease). 