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Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of
Harpreet S Bhatia1, Patrick Trainor2, Samantha Carlisle2
1Division of Cardiovascular Medicine, Department of Medicine University of California, San Diego La Jolla CA.
Insights
Aspirin use significantly reduced coronary heart disease events in individuals with elevated lipoprotein(a) levels. This finding suggests a potential benefit for primary prevention in this high-risk group.
Area of Science:
- Cardiovascular Medicine
- Pharmacology
Background:
- Cardiovascular disease (CVD) risk reduction therapies are limited for individuals with elevated lipoprotein(a), particularly for primary prevention.
- Elevated lipoprotein(a) is potentially associated with thrombosis, necessitating investigation into its relationship with CVD events.
Purpose of the Study:
- To evaluate the association between aspirin use and cardiovascular disease (CVD) events in individuals with elevated lipoprotein(a).
Main Methods:
- Utilized data from the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective cohort study.
- Employed propensity score matching to compare aspirin users with nonusers, controlling for CVD risk factors.
- Analyzed coronary heart disease (CHD) events, stratified by lipoprotein(a) levels (≥50 mg/dL), using Cox proportional hazards models.
Main Results:
- The study included 2183 participants; 423 (19%) had elevated lipoprotein(a) (>50 mg/dL).
- Participants with elevated lipoprotein(a) exhibited higher CVD risk factors and a greater incidence of CHD events.
- Aspirin use was linked to a significant reduction in CHD events among those with elevated lipoprotein(a) (HR, 0.54; P=0.03).
Conclusions:
- Aspirin use demonstrated a significant association with lower risk of coronary heart disease events in individuals with elevated lipoprotein(a) and no prior CVD.
- These findings from an observational, propensity-matched study warrant confirmation through randomized controlled trials.
Background:
Effective therapies for reducing cardiovascular disease (CVD) risk in people with elevated lipoprotein(a) are lacking, especially for primary prevention. Because of the potential association of lipoprotein(a) with thrombosis, we evaluated the relationship between aspirin use and CVD events in people with elevated lipoprotein(a).
Methods And Results:
We used data from the MESA (Multi-Ethnic Study of Atherosclerosis), a prospective cohort study of individuals free of baseline cardiovascular disease. Due to potential confounding by indication, we matched aspirin users to nonusers using a propensity score based on CVD risk factors. We then evaluated the association between aspirin use and coronary heart disease (CHD) events (CHD death, nonfatal myocardial infarction) stratified by baseline lipoprotein(a) level (threshold of 50 mg/dL) using Cox proportional hazards models with adjustment for CVD risk factors. After propensity matching, the study cohort included 2183 participants, including 1234 (57%) with baseline aspirin use and 423 (19%) with lipoprotein(a) >50 mg/dL. Participants with lipoprotein(a) >50 mg/dL had a higher burden of CVD risk factors, more frequent aspirin use (61.7% versus 55.3%, P=0.02), and higher rate of incident CHD events (13.7% versus 8.9%, P<0.01). Aspirin was associated with a significant reduction in CHD events among those with elevated lipoprotein(a) (hazard ratio, 0.54 [95% CI, 0.32-0.94]; P=0.03). Those with lipoprotein(a) >50 mg/dL and aspirin use had similar CHD risk as those with lipoprotein(a) ≤50 mg/dL regardless of aspirin use.
Conclusions:
Aspirin use was associated with a significantly lower risk for CHD events in participants with lipoprotein(a) >50 mg/dL without baseline CVD. The results of this observational propensity-matched study require confirmation in studies with randomization of aspirin use.
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