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Abstract: TH-PO618

The Risks and Benefits of Aspirin for Primary and Secondary Prevention of Mortality, Cardiovascular Disease, and Kidney Failure

Session Information

Category: Hypertension and CVD

  • 1501 Hypertension and CVD: Epidemiology‚ Risk Factors‚ and Prevention

Authors

  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States
  • Mehdi, Ali, Cleveland Clinic, Cleveland, Ohio, United States
  • Sha, Daohang, University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
  • Weir, Matthew R., University of Maryland Baltimore, Baltimore, Maryland, United States
  • Kasner, Scott E., University of Pennsylvania, Philadelphia, Pennsylvania, United States
  • Hassanein, Mohamed, The University of Mississippi Medical Center, Jackson, Mississippi, United States
  • Navaneethan, Sankar D., Baylor College of Medicine, Houston, Texas, United States
  • Go, Alan S., University of California San Francisco School of Medicine, San Francisco, California, United States
  • Lora, Claudia M., University of Illinois Chicago, Chicago, Illinois, United States
  • Jaar, Bernard G., Johns Hopkins University, Baltimore, Maryland, United States
  • Chen, Teresa K., Johns Hopkins University, Baltimore, Maryland, United States
  • Chen, Jing, Tulane University, New Orleans, Louisiana, United States
  • He, Jiang, Tulane University, New Orleans, Louisiana, United States
  • Rahman, Mahboob, Case Western Reserve University, Cleveland, Ohio, United States
Background

CKD is a risk-enhancing factor for cardiovascular disease (CVD) and mortality. The role of aspirin use is unclear in this population since many clinical studies exclude or underrepresent CKD patients. We investigated the risks and benefits of aspirin use in primary and secondary prevention of CVD in the Chronic Renal Insufficiency Cohort (CRIC) Study.

Methods

We identified and analyzed 3,664 CRIC subjects based on absence or presence of pre-existing CVD between 2003 -2018. We performed an intention-to-treat analysis and used multivariable Cox proportional hazards model to examine associations of time varying aspirin use with mortality, a composite of CVD events (myocardial infarction, stroke, and peripheral arterial disease), kidney failure (including dialysis and transplant), and major bleeding.

Results

The overall cohort included 3,664 subjects, including 2,578 (70.3%) individuals in the primary prevention group. Mean age was 57 (+/- 11) years, 46% women, 42% black, 47% diabetic, and 86% hypertensive. The mean estimated Glomerular Filtration Rate (eGFR) was 45 ml/min/1.73 m2 and median 24-hour urine protein was 0.2 grams/day. Median follow up was 11.5 (IQR: 7.4-13) years. Aspirin was not protective in all-cause mortality in those without pre-existing CVD (HR 0.89; 95% CI, 0.75 to 1.05, p=0.15) or those with CVD (HR 1.02; 95% CI, 0.91 to 1.14, p = 0.74). Aspirin was not associated with a reduction of the CVD composite in primary prevention (HR 0.97; 95% CI, 0.77 to 1.23, p=0.79) and in secondary prevention (HR 1.08; 95% CI, 0.89 to 1.31, p=0.46). Aspirin use was not associated with kidney failure (HR 0.95; 95% CI, 0.8 to 1.13, p=0.55) or major bleeding (HR 0.84; 95% CI, 0.61 to 1.15, p=0.27) in primary prevention.

Conclusion

Aspirin use in CKD patients was not associated with reduction in primary or secondary CVD events, progression to kidney failure, or major bleeding. More clinical studies are needed to assess the use of aspirin in primary and secondary prevention in the CKD population.