Long-term aspirin adherence following myocardial infarction and risk of cardiovascular events
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Published on: February 26, 2013
Anna Meta Dyrvig Kristensen1, Manan Pareek2, Kristian Hay Kragholm3
1Department of Cardiology, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Frederiksberg, Copenhagen, Denmark.
Insights
Long-term aspirin use after myocardial infarction (MI) is crucial, as non-adherence increases the risk of major adverse events. However, this increased risk is not observed in women or individuals over 65 years old.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Aspirin is a standard treatment post-myocardial infarction (MI).
- Long-term efficacy and adherence to aspirin after MI require further investigation.
- Understanding adherence patterns is vital for optimizing secondary prevention strategies.
Purpose of the Study:
- To evaluate the effectiveness of long-term aspirin adherence after myocardial infarction.
- To determine the association between aspirin non-adherence and adverse cardiovascular outcomes.
- To explore potential differences in risk based on age and sex.
Main Methods:
- Retrospective cohort study using Danish nationwide registries (2004-2017).
- Included patients (≥40 years) adherent to aspirin one year post-MI.
- Assessed aspirin adherence at 2, 4, 6, and 8 years post-MI.
- Calculated risks of MI, stroke, or death using multivariable logistic regression and standardized average treatment effect modelling.
- Conducted subgroup analyses stratified by sex and age (>65 vs. ≤65 years).
Main Results:
- 40,116 individuals were included in the study.
- Aspirin non-adherence was significantly associated with a higher risk of the composite endpoint (MI, stroke, or death) at all assessed time points.
- The absolute risk was highest between 2-4 years post-MI for both adherent and non-adherent groups.
- The relative risk associated with non-adherence decreased over time, becoming less pronounced from 4 years onwards.
- Notably, aspirin non-adherence was not linked to an increased risk in women or individuals over 65 years old.
Conclusions:
- Non-adherence to long-term aspirin therapy post-MI increases the risk of major adverse cardiovascular events.
- This increased risk is not evident in women or elderly individuals (over 65 years).
- The protective effect of aspirin adherence appears to diminish in relative terms from 4 years post-MI, though absolute risk remains elevated.
Aims:
Aspirin is considered mandatory after myocardial infarction (MI). However, its long-term efficacy has been questioned. This study investigated the effectiveness of long-term aspirin after MI.
Methods And Results:
Patients ≥40 years with MI from 2004 to 2017 who were adherent to aspirin 1 year after MI were included from Danish nationwide registries. At 2, 4, 6, and 8 years after MI, continued adherence to aspirin was evaluated. Absolute and relative risks of MI, stroke, or death at 2 years from each time point were calculated using multivariable logistic regression analysis with average treatment effect modelling standardized for age, sex, and comorbidities. Subgroup analyses were stratified by sex and age > and ≤65 years. Among 40 116 individuals included, the risk of the composite endpoint was significantly higher for non-adherent patients at all time points. The absolute risk was highest at 2-4 years after MI for both adherent [8.34%, 95% confidence interval (CI): 8.05-8.64%] and non-adherent patients (10.72%, 95% CI: 9.78-11.66%). The relative risk associated with non-adherence decreased from 4 years after index-MI and onwards: 1.41 (95% CI: 1.27-1.55) at 4-6 years and 1.21 (95% CI: 1.06-1.36) at 8-10 years (Ptrend = 0.056). Aspirin non-adherence in women and individuals >65 years was not associated with increased risk. Pinteraction at each of the time points: Age - <0.001, <0.001, 0.002, 0.51; Sex - 0.25, 0.02, 0.02, 0.82.
Conclusion:
Non-adherence to long-term aspirin was associated with increased risk of MI, stroke, or death, but not in women or individuals >65 years. The risk decreased from 4 years after MI with near statistical significance.
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