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Aspirin use may not lower risk for MI, stroke in CKD
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SAN DIEGO — Use of aspirin in patients with chronic kidney disease was not associated with reduced odds of nonfatal myocardial infarction, fatal coronary heart disease or stroke, but was linked to lower odds of all-cause mortality, according to data presented at ASN Kidney Week 2018.
“It is well-known that aspirin is effective in the secondary prevention of CVD in the general population, but unclear whether this, or a primary prevention, benefit applies to CKD patients,” Michael Bond, MD, internal medicine resident at Case Western Reserve University/University Hospitals Cleveland Medical Center, told Healio Internal Medicine. “We performed this study to investigate whether aspirin confers any benefit in reducing CVD in patients with CKD.”
Bond and colleagues conducted a secondary analysis of data from the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). The researchers generated a propensity-matched analysis population by examining the differences in baseline characteristics between participants with and without aspirin use for a total of 22,500 participants, including 6,894 non-aspirin users.
The researchers assessed the effect of aspirin across three levels of kidney function including an estimated glomerular filtration rate (eGFR) of 90 mL/min/1.73 m² or more, between 60 and 89 mL/min/1.73 m² and less than 60 mL/min/1.73 m².
There was no significant difference between aspirin users and nonusers in the risk for nonfatal MI or fatal coronary heart disease (OR = 0.98; 95% CI, 0.9-1.06) and stroke (OR = 0.92; 95% CI, 0.82-1.03).
Participants who used aspirin were significantly less likely die from all causes than nonusers (OR = 0.75; 95% CI, 0.7-0.8).
These data remained consistent irrespective of baseline eGFR and preexisting CVD, according to Bond.
“The major takeaway from our work is that for certain populations, such as those with CKD, aspirin may not offer any benefit toward CVD prevention,” Bond said. “It should be noted that as a post-hoc observational analysis, our study is limited only to suggest this association, and does not establish causation or lack thereof between aspirin use and CVD prevention.”
“Future studies, ideally randomized controlled trials, are needed to answer this question more definitively,” he added. “Providers should nonetheless carefully consider whether starting or continuing aspirin for CVD risk reduction confers any benefit to their patients, especially if they have CKD.” – by Alaina Tedesco
Reference:
Bond M, et al. Abstract: TH-PO424. Presented at: ASN Kidney Week; Oct. 23-28, 2018; San Diego.
Disclosure: Bond reports no relevant financial disclosures.