Association between aspirin use and cardiovascular outcomes in ALLHAT participants with and without chronic kidney disease: A post hoc analysis.
Pubmed ID: 33340443
Journal: Journal of clinical hypertension (Greenwich, Conn.)
Publication Date: 02/01/2021
Affiliation: Geriatric Research, Education, and Clinical Centers, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.
MeSH Terms: Humans, Cardiovascular Diseases, Risk Factors, Hypertension, Stroke, Myocardial Infarction, Renal Insufficiency, Chronic, Aspirin
Authors: Rahman M, Desai N, Wilson B, Bond M, Conant A
Cite As: Desai N, Wilson B, Bond M, Conant A, Rahman M. Association between aspirin use and cardiovascular outcomes in ALLHAT participants with and without chronic kidney disease: A post hoc analysis. J Clin Hypertens (Greenwich) 2021 Feb;23(2):352-362. Epub 2020 Dec 19.
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.