Aspirin is well known for its central role in preventing cardio cerebrovascular diseases as an antiplatelet agent. However besides its favorable effects, one must also be fully aware of its side effects such as gastrointestinal complications or cerebral hemorrhage. Particularly when prescribing to Koreans, one must be highly cautious, considering the higher prevalence of helicobacter pylori infection and the contribution of hemorrhagic stroke as a major part of cerebral disease in Korean. Currently the guideline for secondary prevention of cardio cerebrovascular diseases is relatively well established, while the consensus for primary prevention is still controversial. The purpose of this paper would be to summarize the evidence of aspirin usage in preventing cardio cerebrovascular diseases, examine the additional factors one must consider, and help primary physician prescribing aspirin appropriately.