For example, in the recent ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial, observed average 10-year ASCVD risk was <10%, and the overall benefits of prophylactic aspirin by intention-to-treat were negligible.S4.6-17 3. The accumulated trial and observational data to date support avoiding prophylactic aspirin in the setting of known risk factors for increased bleeding A nonexhaustive list of conditions associated with increased bleeding risk includes: a history of previous gastrointestinal bleeding or peptic ulcer disease or bleeding at other sites, age >70 years, thrombocytopenia, coagulopathy, CKD, and concurrent use of other medications that increase bleeding risk, such as nonsteroidal anti-inflammatory drugs, steroids, direct oral anti- coagulants, and warfarin.S4.6-10 5. COST AND VALUE CONSIDERATIONS The growing need to consider value stems directly from the goal of achieving the best possible health outcomes with finite healthcare resources in the pri- mary prevention of CVD.S5-1 Value in health care can be defined as the incremental health benefits of a therapy or procedure relative to its incremental net long-term costs. 