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Abstract: TH-PO424

Effect of Aspirin on Cardiovascular Disease Outcomes in ALLHAT Participants with and Without CKD

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Bond, Michael, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
  • Desai, Niraj, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
  • Wilson, Brigid, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, United States
  • Rahman, Mahboob, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio, United States
Background

Those with chronic kidney disease (CKD) are at increased risk of cardiovascular disease (CVD), as well as increased CVD-related and all-cause mortality. In the general population, aspirin is effective in the secondary prevention of CVD, for those at high risk of occlusive vascular events. For patients with CKD, however, it remains unclear whether aspirin is useful in either the primary or secondary prevention of CVD.

Methods

We performed a secondary analysis of the randomized controlled trial, Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) to assess the effect of baseline aspirin use on the initial primary endpoint, nonfatal myocardial infarction (MI), or fatal coronary heart disease (CHD) and secondary end points, all-cause mortality and stroke. Differences in baseline characteristics between subjects with and without aspirin use were examined and then used to generate a propensity-matched analysis population. Using conditional logistic regression models, we estimated the effect of aspirin on the outcomes. We created additional models testing for differences in the effect of aspirin across 3 levels of kidney function (eGFR > 90, 60-89, and <60).

Results

The ALLHAT trial (n=33,537) contained 11,250 participants with complete data who reported using aspirin at baseline. There were significant differences in the race, sex, and cardiovascular disease history of aspirin versus non-aspirin users. The propensity-matched dataset included 6,894 non-aspirin users matched with replacement to aspirin users and achieved an analysis population (n=22,500) with balance across possible confounders. The risk of the primary study endpoint (OR = 0.98, 95% CI = 0.90-1.06) and stroke (OR = 0.92, 95% CI = 0.82-1.03), was not significantly different between aspirin users/non-users. Aspirin users were at significantly lower risk of all-cause mortality compared to non-users (OR = 0.75, 95% CI = 0.70-0.80). There were no significant interactions between aspirin and baseline eGFR kidney function for these three endpoints.

Conclusion

Aspirin use is not associated with decreased odds of non-fatal MI, fatal CHD or stroke but is associated with decreased odds of all-cause mortality for participants in the ALLHAT trial. These results are consistent across baseline eGFR.

Funding

  • Veterans Affairs Support