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Dr Samia Mora (Boston, MA, USA) and Dr. John Cleland (Glasgow, Scotland, UK) discuss the indication for (or against) aspirin treatment in primary and secondary prevention of atherosclerotic cardiovascular disease. Dr. John Cleland is Professor of Cardiology at the University of Glasgow, UK. He founded the European Journal of Heart Failure, and he is Past-Chair of the ESC Working Group on heart failure and British Society for Heart Failure. Dr Samia Mora is Professor of Medicine, Harvard Medical School and Associate Physician at Brigham and Women’s Hospital, and Director of the Center for Lipid Metabolomics. Dr. Mora co-developed the free Aspirin-Guide mobile app for aspirin in primary prevention of cardiovascular disease (available on the web on www.aspiringuide.com), and she is Co-Principal Investigator of the Women’s Health Study. The interview was recorded on January 24th, 2025. Moderators: Prof. Dr. Dr. Stephan Schirmer (Kaiserslautern, Germany) and Prof. Dr. Gunnar Heine (Frankfurt, Germany). Articles discussed: Aspirin for Secondary Prevention of Atherosclerosis-Evidence or Dogma? Cleland JGF JAMA Cardiol 2024 doi: 10.1001/jamacardio.2024.4335 Aspirin to target arterial events in chronic kidney disease (ATTACK): study protocol for a multicentre, prospective, randomised, open-label, blinded endpoint, parallel group trial of low-dose aspirin vs. standard care for the primary prevention of cardiovascular disease in people with chronic kidney disease. Gallagher H et al. Trials 2022 doi: 10.1186/s13063-022-06132-z Aspirin versus clopidogrel for chronic maintenance monotherapy after percutaneous coronary intervention (HOST-EXAM): an investigator-initiated, prospective, randomised, open-label, multicentre trial. Koo BK et al.; HOST-EXAM investigators. Lancet 2021 doi: 10.1016/S0140-6736(21)01063-1 Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease: Shared Decision Making in Clinical Practice. Mora S, Ames JM, Manson JE JAMA 2016 doi: 10.1001/jama.2016.8362 Whom to Treat for Primary Prevention of Atherosclerotic Cardiovascular Disease: The Aspirin Dilemma. Mora S, Shufelt CL, Manson JE. JAMA Intern Med 2022 doi: 10.1001/jamainternmed.2022.1365 Aspirin for the Primary Prevention of Atherosclerotic Cardiovascular Disease in Women. Shufelt CL, Mora S, Manson JE. JAMA 2022 doi: 10.1001/jama.2022.11951 Aspirin for Primary Prevention of Atherosclerotic Cardiovascular Disease: Advances in Diagnosis and Treatment. Mora S, Manson JE. JAMA Intern Med 2016 doi: 10.1001/jamainternmed.2016.2648 Pantoprazole to Prevent Gastroduodenal Events in Patients Receiving Rivaroxaban and/or Aspirin in a Randomized, Double-Blind, Placebo-Controlled Trial. Moayyedi P et al.; COMPASS Investigators. Gastroenterology 2019 doi: 10.1053/j.gastro.2019.04.041 Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease. Eikelboom JW, et al.; COMPASS Investigators. N Engl J Med 2017 doi: 10.1056/NEJMoa1709118 Long-term follow-up of the West of Scotland Coronary Prevention Study. Ford I et al.; West of Scotland Coronary Prevention Study Group. N Engl J Med 2007 doi: 10.1056/NEJMoa065994 Beta-Blockers after Myocardial Infarction and Preserved Ejection Fraction. Yndigegn T et al.; REDUCE-AMI Investigators N Engl J Med 2024 doi: 10.1056/NEJMoa2401479 Polypill with or without Aspirin in Persons without Cardiovascular Disease. Yusuf S et al.; International Polycap Study 3 Investigators. N Engl J Med 2021 doi: 10.1056/NEJMoa2028220 Polypill Strategy in Secondary Cardiovascular Prevention. Castellano JM et al.; SECURE Investigators. N Engl J Med 2022 doi: 10.1056/NEJMoa2208275 Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. ASCEND Study Collaborative Group; Bowman L et al. N Engl J Med 2018 doi: 10.1056/NEJMoa1804988