Risks vs Benefits of Routine Prophylactic Aspirin in Patients Without Known Heart Disease

The following article is part of conference coverage from the 2018 AHA Scientific Sessions in Chicago, Illinois.The Cardiology Advisor’s staff will be reporting breaking news associated with research conducted by leading experts in cardiology. Check back for the latest news from AHA 2018.

CHICAGO — Taking preventative aspirin reduces the risk for ST-elevation myocardial infarction (STEMI) for patients without known heart disease in a primary prevention setting, and may not increase the risk for gastrointestinal bleeding, according to research presented at the Scientific Sessions of the American Heart Association, held November 10-12.

The United States Preventive Services Task Force (USPSTF) recommends preventative aspirin for anyone over the age of 55 without known heart disease.

To examine the efficacy of aspirin as a preventative measure against the development of coronary heart disease and STEMI, and how factors such as age, gender, and concomitant procedures and medications may impact that effect, researchers in the current study analyzed data from the ISACS-TC registry (NCT01218776) on the outcomes and clinical characteristics of patients without cardiovascular disease from January 2010 to January 2018.

Primary endpoints included adjusted 30-day mortality and STEMI rates at clinical presentation. Safety was assessed via data on hemorrhagic stroke, gastrointestinal bleeding, and bleeding from any alternate sites. Logistic regression models were used to obtain estimates.

Of a total 10,076 participants, 1098 participants with a mean age of 66 years (11.3) were in the aspirin group, and 8978 participants with a mean age of 60.3 years (12.0) were in the no-aspirin group.

After multivariable adjustments for sex, age, risk factors, and kidney function, analysis showed that aspirin therapy reduced the rates of clinical presentation with STEMI in the aspirin group with no heterogeneity of efficacy when each of these factors was utilized for subgroup analyses (odds ratio [OR], 0.52; 95% CI, 0.46-0.60; P >.05 for all interactions).

When sequential logistic analyses included concomitant medications as dummy variables, similar treatment effects were found with aspirin therapy (OR, 0.59 for ACE inhibitors; OR, 0.61 for beta-blockers; OR, 0.62 for statins).

Eight participants in the aspirin group (1.4%) experienced bleeding events vs 88 in the no-aspirin group participants (2.4%), with no between-group difference in the rate of hemorrhagic stroke (P =.12 for bleeding events, and P =.28 for hemorrhagic stroke).

Study investigators conclude that “[a]spirin reduces the risk for STEMI without increasing risk for gastrointestinal bleeding in women and men in a primary prevention setting. These data support the routine use of aspirin as recommended by the USPSTF.”

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Reference

Pavasovic S, Amaduzzi PL, Vasiljevic Z, et al. Primary prevention of ischemic heart disease with aspirin reduces the severity of clinical presentation. Presented at: AHA 2018; November 10-12, 2018; Chicago, Illinois. Abstract #2022