Aspirin for primary prevention in patients with high cardiovascular risk: insights from CORE-Thailand registry

Area of Science:

• Cardiology
• Preventive Medicine
• Clinical Epidemiology

Background:

• Aspirin is considered for primary cardiovascular prevention in select non-elderly patients.
• Aggressive cardiovascular risk factor control may modify aspirin's benefit-risk profile.
• The long-term impact of aspirin on major adverse cardiovascular events (MACEs) in high-risk populations requires further investigation.

Purpose of the Study:

• To examine the effect of aspirin for primary prevention on long-term MACEs.
• To evaluate the association between aspirin use and MACEs in Thai patients with multiple cardiovascular risk factors.

Main Methods:

• Prospective, multicenter, observational, longitudinal study (CORE-Thailand registry).
• Inclusion of Thai patients with multiple cardiovascular risk factors, excluding those with established atherosclerotic cardiovascular diseases.
• Propensity score matching was used to analyze aspirin use and MACEs.

Main Results:

• Aspirin use was associated with an increased risk of long-term MACEs in both pre-matching (HR 1.76) and post-matching (HR 1.66) cohorts.
• Patients taking aspirin showed a higher risk of bleeding compared to non-aspirin users (unadjusted HR 2.28).
• The findings were consistent across different analytical approaches.

Conclusions:

• Aspirin use in patients with multiple cardiovascular risk factors is associated with an increased risk of long-term MACEs.
• The study highlights a potential unfavorable benefit-risk ratio for aspirin in this population.
• Results should be interpreted with caution due to the non-randomized study design.