Abstract: The use of aspirin for primary prevention of cardiovascular events in patients at elevated risks for cardiovascular disease (CVD) remains controversial. Some randomized controlled trials have proven the beneficial effect of aspirin in primary prevention. Aspirin prevents deaths, myocardial infarction and ischemic stroke, whereas it increases hemorrhagic stroke and major bleeding. In order to make better use of aspirin in the primary prevention of CVD, we need to estimate the risks of a cardiovascular event in the individual patient. Most guidelines recommend the Framingham risk score that predicts the 10-year risk of developing a cardiovascular event. Recent guidelines present new recommendations for the use of aspirin in the primary prevention. Although aspirin should be used cautiously in the primary prevention of CVD, the beneficial role aspirin plays in the primary prevention of cardiovascular events should be emphasized.