The increasing burden of cardiovascular diseases in developed, as well as developing countries, underscores the need for the more widespread and appropriate use of aspirin in secondary prevention of occlusive vascular events during acute evolving myocardial infarction (MI) and in primary prevention. Aspirin should be far more widely used in a wide range of patients who have suffered a prior occlusive vascular event and in all patients suffering acute MI or occlusive stroke. Finally, in primary prevention, aspirin should be considered for individuals whose 10-year risks of a coronary event are > or = 10%, as an adjunct not alternative to the management of other risk factors. The more widespread and appropriate use of aspirin will avoid many premature deaths in secondary prevention and MIs in primary prevention.