Abstract Despite recent criticism and emerging P2Y12 inhibitors, aspirin maintains its position as the cornerstone antiplatelet agent in atherosclerotic cardiovascular disease (ASCVD) prevention. This article argues that aspirin's advantages extend beyond conventional antiplatelet effects through three mechanisms: (1) dual pharmacodynamic action—antiplatelet + antiinflammatory targeting atherosclerosis as a metabolic-inflammatory disease, (2) established efficacy in both primary and secondary prevention per current ACC/AHA/ESC guidelines, and (3) unexpected screening role in early cancer diagnosis through aspirin-triggered bleeding unmasking silent malignancies. These mechanisms collectively support aspirin as the antiplatelet of first choice in ASCVD management. Contemporary specialists should critically reassess modern attacks on aspirin before abandoning this cornerstone therapy, as in reality aspirin can occur as the better choice in both primary and secondary prevention appl...