Aspirin use was associated with lower odds of rapid abdominal aortic aneurysm progression compared with no aspirin (OR 0.64; 95% CI 0.49-0.89; P=.002), with no significant difference in mortality.
Cohort (n=3,435)
No
Does aspirin use reduce aneurysm progression and adverse clinical outcomes in adult patients with abdominal aortic aneurysm?
In patients with abdominal aortic aneurysm, aspirin use is associated with slower aneurysm progression but does not significantly impact 10-year mortality or rupture/repair rates.
Odds Ratio: 0.64 (95% CI 0.49–0.89)
p-value: p=.002
Importance: Preclinical studies suggest a potential role for aspirin in slowing abdominal aortic aneurysm (AAA) progression and preventing rupture. Evidence on the clinical benefit of aspirin in AAA from human studies is lacking. Objective: To investigate the association of aspirin use with aneurysm progression and long-term clinical outcomes in patients with AAA. Design, Setting, and Participants: This was a retrospective, single-center cohort study. Adult patients with at least 2 available vascular ultrasounds at the Cleveland Clinic were included, and patients with history of aneurysm repair, dissection, or rupture were excluded. All patients were followed up for 10 years. Data were analyzed from May 2022 to July 2023. Main Outcomes and Measures: Clinical outcomes were time-to-first occurrence of all-cause mortality, major bleeding, or composite of dissection, rupture, and repair. Multivariable-adjusted Cox proportional-hazard regression was used to estimate hazard ratios (HR) for all-cause mortality, and subhazard ratios competing-risk regression using Fine and Gray proportional subhazards regression was used for major bleeding and composite outcome. Aneurysm progression was assessed by comparing the mean annualized change of aneurysm diameter using multivariable-adjusted linear regression and comparing the odds of having rapid progression (annual diameter change >0.5 cm per year) using logistic regression. Results: A total of 3435 patients (mean SD age 73.7 9.0 years; 2672 male patients 77.5%; 120 Asian, Hispanic, American Indian, or Pacific Islander patients 3.4%; 255 Black patients 7.4%; 3060 White patients 89.0%; and median IQR follow-up, 4.9 2.5-7.5 years) were included in the final analyses, of which 2150 (63%) were verified to be taking aspirin by prescription. Patients taking aspirin had a slower mean (SD) annualized change in aneurysm diameter (2.8 3.0 vs 3.8 4.2 mm per year; P = .001) and lower odds of having rapid aneurysm progression compared with patients not taking aspirin (adjusted odds ratio, 0.64; 95% CI, 0.49-0.89; P = .002). Aspirin use was not associated with risk of all-cause mortality (adjusted HR aHR, 0.92; 95% CI, 0.79-1.07; P = .32), nor was aspirin use associated with major bleeding (aHR, 0.88; 95% CI, 0.76-1.03; P = .12), or composite outcome (aHR, 1.16; 95% CI, 0.93-1.45; P = .09) at 10 years. Conclusions: In this retrospective study of a clinical cohort of 3435 patients with objectively measured changes in aortic aneurysm growth, aspirin use was significantly associated with slower progression of AAA with a favorable safety profile.
Hariri et al. (Tue,) conducted a cohort in Abdominal aortic aneurysm (n=3,435). Aspirin vs. No aspirin was evaluated on Rapid aneurysm progression (annual diameter change >0.5 cm per year) (OR 0.64, 95% CI 0.49-0.89, p=.002). Aspirin use was associated with lower odds of rapid abdominal aortic aneurysm progression compared with no aspirin (OR 0.64; 95% CI 0.49-0.89; P=.002), with no significant difference in mortality.