Anthony A Bavry1,2, Islam Y Elgendy1, Yedid Elbez3,4, Ahmed N Mahmoud1, Emmanuel Sorbets3,4,5, Philippe Gabriel Steg3,4,6, Deepak L Bhatt7. 1. Department of Medicine, University of Florida, Gainesville, Florida. 2. North Florida/South Georgia Veterans Health System, Gainesville, Florida. 3. Département Hospitalo-Universitaire FIRE, Université Paris Diderot, AP-HP, Hôpital Bichat, and INSERM U-1148, Paris, France. 4. FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France. 5. Service de cardiologie, Hôpital Avicenne, AP-HP, and Université Paris 13, Bobigny, France. 6. National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom. 7. Brigham and Women's Hospital Heart and Vascular Center, Harvard Medical School, Boston, Massachusetts.
Abstract
BACKGROUND: The benefit of aspirin among patients with stable atherosclerosis without a prior ischemic event is not well defined. HYPOTHESIS: Aspirin would be of benefit in outpatients with atherosclerosis with prior ischemic events, but not in those without ischemic events. METHODS: Subjects from the Reduction of Atherothrombosis for Continued Health registry were divided according to prior ischemic event (n =21 724) vs stable atherosclerosis, but no prior ischemic event (n = 11 872). Analyses were propensity score matched. Aspirin use was updated at each clinic visit and considered as a time-varying covariate. The primary outcome was the first occurrence of cardiovascular death, myocardial infarction, or stroke. RESULTS: In the group with a prior ischemic event, aspirin use was associated with a marginally lower risk of the primary outcome at a median of 41 months (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.65-1.01, P = 0.06). In the group without a prior ischemic event, aspirin use was not associated with a lower risk of the primary outcome at a median of 36 months (HR: 1.03, 95% CI: 0.73-1.45, P = 0.86). CONCLUSIONS: In this observational analysis of outpatients with stable atherosclerosis, aspirin was marginally beneficial among patients with a prior ischemic event; however, there was no apparent benefit among those with no prior ischemic event.
BACKGROUND: The benefit of aspirin among patients with stable atherosclerosis without a prior ischemic event is not well defined. HYPOTHESIS: Aspirin would be of benefit in outpatients with atherosclerosis with prior ischemic events, but not in those without ischemic events. METHODS: Subjects from the Reduction of Atherothrombosis for Continued Health registry were divided according to prior ischemic event (n =21 724) vs stable atherosclerosis, but no prior ischemic event (n = 11 872). Analyses were propensity score matched. Aspirin use was updated at each clinic visit and considered as a time-varying covariate. The primary outcome was the first occurrence of cardiovascular death, myocardial infarction, or stroke. RESULTS: In the group with a prior ischemic event, aspirin use was associated with a marginally lower risk of the primary outcome at a median of 41 months (hazard ratio [HR]: 0.81, 95% confidence interval [CI]: 0.65-1.01, P = 0.06). In the group without a prior ischemic event, aspirin use was not associated with a lower risk of the primary outcome at a median of 36 months (HR: 1.03, 95% CI: 0.73-1.45, P = 0.86). CONCLUSIONS: In this observational analysis of outpatients with stable atherosclerosis, aspirin was marginally beneficial among patients with a prior ischemic event; however, there was no apparent benefit among those with no prior ischemic event.
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