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Association of cardiometabolic risk burden with gastrointestinal bleeding in aspirin users
Yajing Wei1, Jiamin Yan1, Ziting Gao1
1Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, No 1, Xue Yuan Road, University Town, Fuzhou, Fujian, 350108, China.
Insights
Higher cardiometabolic risk burden significantly increases gastrointestinal (GI) bleeding risk in aspirin users. Tailored prevention strategies are needed for these patients.
Area of Science:
- Cardiology
- Gastroenterology
- Public Health
Background:
- Aspirin is frequently prescribed for ischemic cardiovascular diseases, often co-occurring with cardiometabolic disorders.
- The relationship between cardiometabolic risk and gastrointestinal (GI) bleeding in aspirin users requires investigation.
Purpose of the Study:
- To assess the impact of cardiometabolic risk burden on the incidence of first-time GI bleeding among individuals using aspirin.
- To quantify the association between increasing cardiometabolic risk factors and GI bleeding risk.
Main Methods:
- A cohort study utilizing UK Biobank data, including patients with ischemic cardiovascular disease and aspirin prescriptions.
- Cardiometabolic risk burden was calculated by summing the presence of obesity, diabetes, dyslipidemia, and hypertension.
- Cox proportional hazards models were employed to determine hazard ratios (HR) and 95% confidence intervals (CI) for GI bleeding.
Main Results:
- Over a mean follow-up of 13.4 years, GI bleeding incidence rose with increasing cardiometabolic risk factors (0-4), from 4.53 to 9.64 per 1000 person-years.
- Compared to those without risk factors, adjusted HR for GI bleeding increased with burden (1.09 to 1.95), with diabetes and hypertension showing pronounced effects (HR=1.24 each).
- The association was stronger in individuals with prior GI issues, younger adults, and males.
Conclusions:
- A higher cardiometabolic risk burden is significantly associated with an elevated risk of GI bleeding in aspirin users.
- These findings underscore the need for personalized GI bleeding prevention strategies in aspirin users, considering their cardiometabolic risk profile.
Introduction:
Aspirin is widely used in patients with ischemic cardiovascular diseases, most of whom have cardiometabolic disorders. This study aimed to investigate the impact of cardiometabolic risk burden on first gastrointestinal (GI) bleeding in aspirin users.
Methods:
This is a cohort study, including patients with ischemic cardiovascular disease and aspirin prescription from UK biobank. Exposure was cardiometabolic risk burden, calculated as the sum of the presence of cardiometabolic risk factors, including obesity, diabetes, dyslipidemia and hypertension. GI bleeding obtained from hospital inpatient admissions was the outcome. The Cox proportional hazards model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI).
Results:
After a mean of 13.4 years of follow-up, we found that among 12,781 aspirin users, the incidence rate of GI bleeding was increasing with the growing cardiometabolic risk burden (number of cardiometabolic risk factors from 0 to 4), ranging from 4.53, 4.98, 5.47, 8.08 to 9.64 per 1000 person-years. As compared to participants without cardiometabolic risk factors and after adjustment for potential confounders, the elevated GI risk was greater with the increased burden with HR ranging from 1.09, 1.16, 1.59 to 1.95 (P-trend < 0.001), in which diabetes (HR = 1.24, 95% CI = 1.02-1.51) and hypertension (HR = 1.24, 95% CI = 1.08-1.42) may play a more pronounced role. Stratified analysis found that the association was stronger in those with history of gastrointestinal disorders, younger adults or males.
Conclusions:
Aspirin users with higher burden of cardiometabolic risk experienced significantly higher risk of GI bleeding, calling for concern of tailored strategy for GI bleeding prevention in aspirin users related to cardiometabolic risk burden.
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