Key result
Aspirin in high-risk hypertension is not linked to reduced CHD or MI despite lower all-cause mortality.
Why the study?
It is unclear whether aspirin is beneficial for the prevention of cardiovascular disease in patients with chronic kidney disease.
Does baseline aspirin use reduce nonfatal MI, fatal CHD, stroke, or all-cause mortality in hypertensive patients at high cardiovascular risk with and without CKD?
Cohort (n=22,500)
Does baseline aspirin use reduce nonfatal MI, fatal CHD, stroke, or all-cause mortality in hypertensive patients at high cardiovascular risk with and without CKD?
In high-risk hypertensive patients, baseline aspirin use was associated with reduced all-cause mortality but did not significantly reduce the risk of nonfatal MI, fatal CHD, or stroke, regardless of baseline kidney function.
Aspirin not linked to fewer ischemic events in high-risk hypertension; leaves open mortality association for randomized confirmation.
It is unclear whether aspirin is beneficial for prevention of CVD in patients with CKD. We performed a secondary analysis of the ALLHAT trial to assess the effect of baseline aspirin use on nonfatal myocardial infarction (MI) or fatal coronary heart disease (CHD), all-cause mortality, and stroke. Baseline characteristics of aspirin users and nonusers were used to generate propensity-matched cohorts. Using conditional Cox proportional hazard regression models, we examined the effect of aspirin on the outcomes in the cohort at large and across 3 levels of kidney function (eGFR ≥90, 60-89, and <60). 11 250 ALLHAT participants reported using aspirin at baseline. The propensity-matched dataset included 6894 nonusers matched with replacement to achieve a balanced analysis population (n = 22 500). Risk of fatal CHD or nonfatal MI (HR = 0.94, 95% CI 0.86-1.02) and stroke (HR = 1.01, 95% CI 0.89-1.15) was not significantly different between groups. Aspirin users were at significantly lower risk of all-cause mortality compared to nonusers (HR = 0.82, 95% CI 0.76-0.88). Aspirin use was not associated with incidence of fatal CAD or nonfatal MI in patients with CVD (HR = 0.93, CI 0.84-1.04) or without CVD at baseline (HR = 1.04, CI 0.82-1.32). Results were consistent across strata of GFR (interaction p value NS). In hypertensive patients at high cardiovascular risk, aspirin use is not associated with risk of nonfatal MI, fatal CHD, or stroke; however, aspirin use is associated with lower risk of all-cause mortality. These results are consistent across baseline eGFR.
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Desai et al. (2020) conducted a cohort in Hypertension at high cardiovascular risk with or without chronic kidney disease (n=22,500). Aspirin vs. No aspirin was evaluated on Fatal coronary heart disease or nonfatal myocardial infarction (HR 0.94, 95% CI 0.86-1.02, p=NS). Baseline aspirin use in hypertensive patients at high cardiovascular risk was not associated with a reduced risk of fatal CHD or nonfatal MI (HR 0.94; 95% CI 0.86-1.02), but was associated with lower all-cause mortality.
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