Association of cardiometabolic risk burden with gastrointestinal bleeding in aspirin users

Aspirin is widely used in patients with ischemic cardiovascular diseases, most of whom have cardiometabolic disorders. This study aimed to investigate the impact of cardiometabolic risk burden on first gastrointestinal (GI) bleeding in aspirin users. This is a cohort study, including patients with ischemic cardiovascular disease and aspirin prescription from UK biobank. Exposure was cardiometabolic risk burden, calculated as the sum of the presence of cardiometabolic risk factors, including obesity, diabetes, dyslipidemia and hypertension. GI bleeding obtained from hospital inpatient admissions was the outcome. The Cox proportional hazards model was used to calculate the hazard ratio (HR) and 95% confidence interval (CI). After a mean of 13.4 years of follow-up, we found that among 12,781 aspirin users, the incidence rate of GI bleeding was increasing with the growing cardiometabolic risk burden (number of cardiometabolic risk factors from 0 to 4), ranging from 4.53, 4.98, 5.47, 8.08 to 9.64 per 1000 person-years. As compared to participants without cardiometabolic risk factors and after adjustment for potential confounders, the elevated GI risk was greater with the increased burden with HR ranging from 1.09, 1.16, 1.59 to 1.95 (P-trend < 0.001), in which diabetes (HR = 1.24, 95% CI = 1.02–1.51) and hypertension (HR = 1.24, 95% CI = 1.08–1.42) may play a more pronounced role. Stratified analysis found that the association was stronger in those with history of gastrointestinal disorders, younger adults or males. Aspirin users with higher burden of cardiometabolic risk experienced significantly higher risk of GI bleeding, calling for concern of tailored strategy for GI bleeding prevention in aspirin users related to cardiometabolic risk burden. • Aspirin is widely used in patients with ischemic cardiovascular diseases, most of whom have complicated by cardiometabolic disorders. • This study found the incidence rate of GI bleeding was increasing with the growing cardiometabolic risk burden, in which diabetes and hypertension may play a more pronounced role. • Our findings call for concern of GI bleeding in the aspirin users with higher burden of cardiometabolic risk and more studies are needed to provide evidence for tailored strategy.