To assess the value of the latest recommendations, it is worth considering what new evidence has emerged since those issued in 2009. In that year, the Antithrombotic Trialists' (ATT) Collaboration reported a collaborative meta-analysis of individual-patient data from 6 primary prevention trials of 95 000 persons, which included a detailed assessment of how the cardiovascular benefits and bleeding risks compared in different prognostic groups (3). The latest recommendations from the USPSTF consider 5 more primary prevention trials of about 25 000 persons, most of whom were at low risk for CVD. The relative risk estimates for nonfatal MI (22% reduction), stroke (no significant effect), mortality (no significant effect), and serious gastrointestinal bleeding (58% increase) were almost identical to those reported by the ATT. Perhaps not surprisingly, the ATT and USPSTF both find that aspirin yields small cardiovascular benefits (that is, a reduction in nonfatal MI) and small bleeding risks (serious gastrointestinal bleeding and, much less commonly, hemorrhagic stroke); further, both find that the net benefit (cardiovascular benefit − bleeding risk) is small—about 1 to 2 fewer events per 1000 person-years. The ATT analysis showed that the absolute risks for CVD and bleeding are positively correlated, so the net benefits of aspirin are likely to remain small even among persons with several risk factors for CVD. Given that these risk factors and bleeding overlap substantially, it seems unlikely that meta-analyses that include new trials, even the ongoing trials, will yield well-defined groups in which cardiovascular and bleeding risks are uncoupled.