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Low-dose aspirin in the primary prevention of cardiovascular diseases: A retrospective, propensity score matched
Seong Pyo Kim1, Jiwon Ryu2, Su Hwan Kim3
1Interdisciplinary Program of Medical Informatics, Seoul National University College of Medicine, Seoul, Republic of Korea; Integrated Major in Innovative Medical Science, Seoul National University Graduate School, Republic of Korea.
Insights
Low-dose aspirin use for primary prevention of cardiovascular disease (CVD) shows benefits across diverse populations. However, increased bleeding risk necessitates careful consideration in clinical practice.
Area of Science:
- Cardiology
- Preventive Medicine
- Pharmacology
Background:
- The efficacy of aspirin for primary prevention of cardiovascular disease (CVD) remains debated despite recent guideline updates.
- Real-world data is crucial for understanding aspirin's role in primary CVD prevention.
Purpose of the Study:
- To evaluate the real-world effectiveness of low-dose aspirin in preventing cardiovascular events.
- To assess the impact of aspirin on CVD prevention across different demographic and clinical subgroups.
Main Methods:
- A large cohort study involving over 4 million participants screened between 2002-2008.
- Propensity score matching was used to compare outcomes between low-dose aspirin users (≤100 mg/day) and non-users.
- A Cox proportional-hazards model analyzed the incidence of CVD events and bleeding episodes.
Main Results:
- Aspirin demonstrated a significant protective effect against total CVD events (HR: 0.737).
- This protective effect was consistent across men, women, younger individuals (<65 years), and those with diabetes or hypertension.
- Aspirin use was associated with a 1.4-1.5 times increased risk of bleeding events.
Conclusions:
- Low-dose aspirin provides a general protective effect against CVD in real-world settings, irrespective of age, sex, or comorbidities.
- While beneficial even at younger ages, the elevated bleeding risk underscores the need for cautious prescription of aspirin.
Background And Aims:
Although the guidelines have been revised recently, the effect of aspirin for the primary prevention of cardiovascular disease (CVD) is still controversial. Thus, we aimed to evaluate the effect of aspirin on primary prevention in the real world.
Methods:
Among the 4,266,268 participants without a history of CVD or previous prescription of aspirin and other antiplatelet agents who were screened between 2002 and 2008, 268,963 persons who were prescribed low-dose aspirin (≤100 mg/day) over 90 days in 2002-2008 and 1,075,852 persons who did not receive aspirin were selected after propensity score matching. A Cox proportional-hazards model was used to evaluate the effect of low-dose aspirin on the development of CVD and bleeding episodes.
Results:
Aspirin showed a protective effect on total CVD events (hazard ratio (HR); 0.737, 95% confidence interval; 0.729-0.745). The protective effect of aspirin on total CVD events was significant in men, women and even in young participants (<65 years). Aspirin had a protective effect in participants with diabetes or hypertension against all subcategories of CVD. The HR of bleeding risk was 1.4-1.5 in aspirin group.
Conclusions:
Low-dose aspirin generally showed a protective effect against CVD regardless of age, sex, and underlying comorbidities in the real world. Though, the effect of aspirin was evident at a young age, the risk of bleeding was also high (1.4-1.5 times), and thus, careful prescription is required.
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