Aspirin may not lower risk for first CV event in those with family history of premature MI
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In people with a family history of parental premature MI, aspirin for primary prevention was not associated with reduced CV events or overall mortality, according to data published in the European Journal of Preventive Cardiology.
“The family history of premature CVD is a major risk enhancer for the occurrence of CV events,” Daniel Caldeira, MD, PhD, professor at the Cardiovascular Center of the University of Lisbon, Portugal, and colleagues wrote. “While family history of CVD is conceptually simple, it results from a complex interplay between environment and genetics, as both parents and siblings share not only a genetic predisposition but also lifestyle behaviors that can increase the risk. The role of aspirin in this population is still controversial, and current recommendations consider aspirin only in individuals with a higher baseline risk of CV disease — in which the putative benefits would eventually outweigh the known bleeding risk.”
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The VITAL trial
Caldeira and colleagues conducted a retrospective analysis of the VITAL trial cohort to assess the association between parental history of premature MI and aspirin exposure with improved CV outcomes.
For the placebo-controlled VITAL trial, 25,871 participants were randomly assigned vitamin D3 (cholecalciferol) 2,000 IU per day or placebo and omega-3 fatty acids 1 g per day or placebo for the prevention of major CV events and invasive cancer of any type.
As Healio previously reported, neither omega-3 nor vitamin D3 supplements for primary prevention reduced major CV events or development of invasive cancers compared with placebo at 5 years, but some secondary endpoints showed promising signals.
Parental premature MI and use of aspirin
Among the 22,915 VITAL participants who reported data regarding family history of premature MI, 3,653 had a family history of premature MI and 19,262 did not.
Participants with a family history of premature MI in VITAL were younger (66.7 vs. 66.03 years; P < .001) and less likely to be women (51% vs. 46%; P < .001) compared with those without a family history. In addition, those with a family history of premature MI were more likely to have risk factors such as hypertension (48% vs. 54%; P < .001) and diabetes (13% vs. 16%; P < .001).
Researchers reported that participants with a parental history of premature MI were more often prescribed statins (34% vs. 41%; P < .001) or aspirin (45% vs. 51%) compared with participants without a family history.
History of premature parental MI was associated with greater overall mortality (HR = 1.33; 95% CI, 1.11-1.59) and major adverse CV events (HR = 1.31; 95% CI, 1.08-1.6) compared with no history.
Researchers observed that in participants with a family history of premature MI, aspirin use was not associated with a significant decrease in overall mortality (HR = 0.77; 95% CI, 0.56-1.08), major adverse CV events (HR = 0.81; 95% CI, 0.57-1.17) or any secondary outcomes including CV mortality, CHD, stroke and expanded major adverse CV events.
“Regarding the use of aspirin in the primary prevention, there was no significant association between this drug exposure and CV outcomes or all-cause mortality reduction,” the researchers wrote. “There are two plausible reasons for this result: the residual confounding by indication due to the observational nature of this evaluation; and/or the absence of benefit in this population. Guidelines support an informed discussion with patients regarding the risks and benefits of this therapy. However, studies that investigated the effects of aspirin subpopulations with high-risk features did not show a benefit in this intervention, including pooled analysis of subgroup of participants with family history of premature cardiovascular disease, particularly when weighted against the significant increases in bleeding rates.”
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