The evidence is convergent. Multiple independent sources reach the same conclusion, the underlying mechanism is well-characterized, and even the field's most cautious voices treat it as worth doing.
my practice used to be to put patients on a baby aspirin if there was at least one other reason to do so so if they had an elevated LP PLA - if I had an elevated LP little-a if they had a significant enough risk of heart disease that I would feel that that those two things and I fit in that category right so I have a normal LP little a normal LP PLA - but my family history for heart disease is high and my aspirin works was high so that's why I take a baby aspirin
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I used to also think baby aspirin was a reasonable thing to take on a flight you know if you're flying on a long flight you don't want to minimize your risk of a blood clot take a baby aspirin especially if you have another risk factor so any patient I had that had an elevated LP little-a which is increases your risk of blood clotting probably by 2 X although that's still debatable hey those are great you know those are patients that should take too baby aspirin on a flight kind of thing
my view on baby aspirin was if your aspirin works test is positive so the aspirin works test is a test we do in urine that measures metabolites of platelets and basically tries to predict which patients will and won't respond to baby aspirin if that level is high my practice used to be to put patients on a baby aspirin if there was at least one other reason to do so so if they had an elevated LP PLA - if I had an elevated LP little-a if they had a significant enough risk of heart disease that I would feel that that those two things and I fit in that category right
my thinking on this has actually changed in the past month historically I took baby aspirin just because I come from a family where heart disease is rampant and that's sort of you know if you know in the spirit of our good friend Charlie Munger you brought up him I'm gonna go you know show me where I'm gonna die and I'll try to not be there so you know the crystal ball says I'm probably gonna die of heart disease so let's do everything in our power to mitigate it let's keep the lipids as low as possible inflammation as low as possible don't do anything that's gonna exacerbate endothelial dysfunction take the baby aspirin which probably acts primary you know somewhat through yeah it probably has some effect on inflammation but probably the majority of its effect uh is is obviously on platelets and therefore reducing thrombotic events which are the final you know like that's that's what pushes you off the cliff when you have an MI