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Aspirin Use and Mortality in Two Contemporary US Cohorts

Wen-Yi Huang, Sarah E Daugherty, Meredith S Shiels

    Epidemiology (Cambridge, Mass.)
    |September 2, 2017
    PubMed

    Insights

    Daily aspirin use benefits secondary prevention of cardiovascular disease. However, for primary prevention, frequent aspirin use may increase cardiovascular mortality risk, especially in those without prior cardiovascular disease history.

    Area of Science:

    • Cardiovascular Disease Epidemiology
    • Preventive Medicine
    • Clinical Pharmacology

    Background:

    • Daily aspirin is recommended for secondary prevention of cardiovascular disease (CVD).
    • The role of aspirin in primary CVD prevention remains controversial and requires further investigation.

    Purpose of the Study:

    • To investigate the association between aspirin use and mortality in large US cohorts.
    • To differentiate the effects of aspirin on mortality based on CVD history and frequency of use.

    Main Methods:

    • Analysis of 440,277 participants from the NIH-AARP Diet and Health Study and the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial.
    • Ascertainment of aspirin use frequency via self-report and cause of death through death certificates.
    • Multivariate Cox proportional hazards models and meta-analysis to calculate hazard ratios (HRs) and 95% confidence intervals (CIs).

    Main Results:

    • A U-shaped relationship was observed between aspirin use and mortality.
    • Daily aspirin use reduced cardiovascular mortality in individuals with a history of CVD (HR = 0.78).
    • No CVD mortality protection was found for daily aspirin users without prior CVD history (HR = 1.06); increased risk was observed with more frequent use (HR = 1.29).

    Conclusions:

    • Aspirin use is confirmed for secondary CVD prevention.
    • Caution is advised for frequent aspirin use in primary prevention, particularly in individuals without a history of CVD.
    • The findings highlight the importance of personalized aspirin use based on individual CVD risk and history.
    Abstract

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