Aspirin use did not significantly reduce major adverse cardiovascular events (HR 0.60; 95% CI 0.31-1.17; P=0.1) in adults without ASCVD but with elevated Lp(a) or high-risk LPA genotypes.
Meta-Analysis (n=6,628)
Does aspirin reduce major adverse cardiovascular events in adults without ASCVD but with elevated Lp(a) or high-risk LPA genotypes?
In adults without ASCVD but with elevated Lp(a) or high-risk LPA genotypes, aspirin for primary prevention did not significantly reduce cardiovascular events and was associated with numerically higher bleeding risk.
Effect estimate: HR 0.60 (95% CI 0.31-1.17)
p-value: p=0.1
Abstract Aims Routine aspirin use for primary prevention yields modest cardiovascular benefit but increases bleeding risk in average-risk adults. Whether individuals with elevated lipoprotein(a) Lp(a) levels or high-risk LPA variants derive greater benefit remains uncertain. Methods and results Following Cochrane and PRISMA guidelines, we systematically searched PubMed/MEDLINE, Embase, and Cochrane Central for studies of adults without ASCVD, elevated Lp(a) (≥50 mg/dL), high-risk LPA genotypes, or elevated genetic risk scores, comparing aspirin vs. no aspirin use. Random-effects meta-analyses using restricted maximum-likelihood (REML) estimation with Hartung–Knapp–Sidik–Jonkman (HKSJ) adjustment were used to pool hazard ratios (HR) and 95% confidence intervals (CI). In six studies, 6628 participants were included. Pooled random effects showed no significant reduction in major adverse cardiovascular events (MACE) with aspirin (HR = 0.60; 95% CI 0.31–1.17; P = 0.1) or clinical bleeding events (HR = 1.24; 95% CI 0.83–1.87; P = 0.18). Subgroup analyses showed a nonsignificant reduction MACE among elevated Lp(a) (HR = 0.63; 95% CI 0.16 to 2.49; P = 0.284) and statistically significant reduction among LPA rs3798220 carriers (HR = 0.37; 95% CI 0.19 to 0.71; P = 0.003), though this finding was not consistent in the sensitivity analyses. Conclusion Among adults without ASCVD but with elevated Lp(a) or high-risk LPA genotypes, aspirin use did not confer a statistically significant cardiovascular benefit and was associated with numerically higher bleeding risk. The apparent reduction seen in rs3798220 carriers was inconsistent and likely reflects small-sample bias.
Lopes et al. (Wed,) conducted a meta-analysis in Primary prevention in adults with elevated Lp(a) or genetic susceptibility (n=6,628). Aspirin vs. No aspirin use was evaluated on Major adverse cardiovascular events (MACE) (HR 0.60, 95% CI 0.31-1.17, p=0.1). Aspirin use did not significantly reduce major adverse cardiovascular events (HR 0.60; 95% CI 0.31-1.17; P=0.1) in adults without ASCVD but with elevated Lp(a) or high-risk LPA genotypes.
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