Abstract: Aspirin is a commonly used antithrombotic drug for the prevention and treatment of cardiovascular diseases （CVD） in the elderly.However，older people are at high risk of bleeding，and aspirin-related bleeding increases significantly with age.In recent years，the recommendations for aspirin in primary prevention of CVD in foreign guidelines tend to be conservative.In primary prevention，how to select and standardize aspirin use and take into account the benefits and safety should be highly valued.This article reviews the evidence，guidelines and consensus and specific issues concerning aspirin for primary prevention of CVD in the elderly.Low-dose aspirin is recommended in individuals if the benefit exceeds the risk，and the assessment is based on the patient's age，risk factors for CVD and so on.

Key words: Cardiovascular diseases, Aspirin, Primary prevention, Gastrointestinal hemorrhage

摘要： 阿司匹林是老年人心血管疾病防治的常用药物。老年人是出血的高危人群，随着年龄增长，阿司匹林相关的出血风险明显增加。近年来，国外指南对阿司匹林用于心血管疾病一级预防的推荐趋于保守。在一级预防中如何选择和规范使用阿司匹林，兼顾获益与安全性，应引起高度重视。本文通过对阿司匹林一级预防的证据、指南与共识以及老年人使用阿司匹林一级预防的问题进行综述，建议根据患者的年龄、心血管疾病的危险因素等进行评估，强调在获益超过风险的前提下使用小剂量阿司匹林。

关键词: 心血管疾病, 阿司匹林, 一级预防, 胃肠出血