Fergus Hamilton1,2, David Arnold3,4, William Henley5, Rupert A Payne1. 1. Centre for Academic Primary Care, University of Bristol, Bristol, UK. 2. Department of Infection Science, Southmead Hospital, Bristol, UK. 3. Academic Respiratory Unit, Southmead Hospital, Bristol, UK. 4. Translational Health Sciences, University of Bristol, Bristol, UK. 5. Health Statistics Group, University of Exeter, Exeter, UK.
Abstract
BACKGROUND: Ischaemic stroke and myocardial infarction (MI) are common after pneumonia and are associated with long-term mortality. Aspirin may attenuate this risk and should be explored as a therapeutic option. METHODS: We extracted all patients with pneumonia (aged over 50 years) from the Clinical Practice Research Datalink (CPRD), a large UK primary care database, from inception until January 2019. We then performed a prior event rate ratio (PERR) analysis with propensity score matching (PSM), an approach that allows for control of measured and unmeasured confounding, with aspirin usage as the exposure and ischaemic events as the outcome. The primary outcome was the combined outcome of ischaemic stroke and MI. Secondary outcomes were ischaemic stroke and MI individually. Relevant confounders (smoking, comorbidities, age and gender) were included in the analysis. FINDINGS: 48 743 patients were eligible for matching. Of these, 9864 were aspirin users who were matched to 9864 non-users. Aspirin users had a reduced risk of the primary outcome (adjusted hazard ratio 0.64, 95% CI 0.52-0.79) in the PERR analysis. For both secondary outcomes, aspirin use was also associated with a reduced risk for MI (hazard ratio 0.46, 95% CI 0.30-0.72) and stroke (hazard ratio 0.70, 95% CI 0.55-0.91), respectively. INTERPRETATION: This study provides supporting evidence that aspirin use is associated with reduced ischaemic events after pneumonia in a primary care setting. This drug may have a future clinical role in preventing this important complication.
BACKGROUND:Ischaemic stroke and myocardial infarction (MI) are common after pneumonia and are associated with long-term mortality. Aspirin may attenuate this risk and should be explored as a therapeutic option. METHODS: We extracted all patients with pneumonia (aged over 50 years) from the Clinical Practice Research Datalink (CPRD), a large UK primary care database, from inception until January 2019. We then performed a prior event rate ratio (PERR) analysis with propensity score matching (PSM), an approach that allows for control of measured and unmeasured confounding, with aspirin usage as the exposure and ischaemic events as the outcome. The primary outcome was the combined outcome of ischaemic stroke and MI. Secondary outcomes were ischaemic stroke and MI individually. Relevant confounders (smoking, comorbidities, age and gender) were included in the analysis. FINDINGS: 48 743 patients were eligible for matching. Of these, 9864 were aspirin users who were matched to 9864 non-users. Aspirin users had a reduced risk of the primary outcome (adjusted hazard ratio 0.64, 95% CI 0.52-0.79) in the PERR analysis. For both secondary outcomes, aspirin use was also associated with a reduced risk for MI (hazard ratio 0.46, 95% CI 0.30-0.72) and stroke (hazard ratio 0.70, 95% CI 0.55-0.91), respectively. INTERPRETATION: This study provides supporting evidence that aspirin use is associated with reduced ischaemic events after pneumonia in a primary care setting. This drug may have a future clinical role in preventing this important complication.
Authors: Jennifer A Davidson; Amitava Banerjee; Liam Smeeth; Helen I McDonald; Daniel Grint; Emily Herrett; Harriet Forbes; Richard Pebody; Charlotte Warren-Gash Journal: Lancet Digit Health Date: 2021-12
Authors: Kristján G Rögnvaldsson; Agnar Bjarnason; Karl Kristinsson; Hörður T Bragason; Helga Erlendsdóttir; Guðmundur Þorgeirsson; Magnús Gottfreðsson Journal: J Intern Med Date: 2022-03-30 Impact factor: 13.068