Impact of Aspirin According to Type of Stable Coronary Artery Disease: Insights from a Large International Cohort - 23/01/15
, Yan Gong, PhD c, Eileen M. Handberg, PhD b, Rhonda M. Cooper-DeHoff, PharmD, MS b, c, Carl J. Pepine, MD bAbstract |
Background |
Aspirin is recommended in stable coronary artery disease based on myocardial infarction and stroke studies. However, benefit among stable coronary artery disease patients who have not suffered an acute ischemic event is uncertain. The objective of this study was to evaluate the impact of aspirin in stable coronary artery disease. We hypothesized that aspirin's benefit would be attenuated among individuals with stable coronary artery disease but no prior ischemic event.
Methods |
An observational study was conducted from the INternational VErapamil-SR/Trandolapril STudy cohort. Ambulatory patients ≥50 years of age with clinically stable coronary artery disease requiring antihypertensive drug therapy (n = 22,576) were classified “ischemic” if they had a history of unstable angina, myocardial infarction, transient ischemic attack, or stroke at the baseline visit. All others were classified “non-ischemic.” Aspirin use was updated at each clinic visit and considered as a time-varying covariate in a Cox regression model. The primary outcome was first occurrence of all-cause mortality, myocardial infarction, or stroke.
Results |
At baseline, 56.7% of all participants used aspirin, which increased to 69.3% at study close out. Among the “non-ischemic” group (n = 13,091), aspirin was not associated with a reduction in risk (hazard ratio [HR] 1.11; 95% confidence interval [CI], 0.97-1.28; P = .13); however, among the “ischemic” group (n = 9485), aspirin was associated with a reduction in risk (HR 0.87; 95% CI, 0.77-0.99; P = .033).
Conclusions |
In patients with stable coronary artery disease and hypertension, aspirin use was associated with reduced risk for adverse cardiovascular outcomes among those with prior ischemic events. Among patients with no prior ischemic events, aspirin use was not associated with a reduction in risk.
Le texte complet de cet article est disponible en PDF.Keywords : Adverse cardiovascular events, Aspirin, Coronary artery disease, Ischemic heart disease
Plan
| Funding: No funding was obtained for this study. The original INVEST study was funded by a grant from BASF Pharma, Ludwigshafen, Germany; Abbott Laboratories, Abbott Park, IL, USA, and the University of Florida Research Foundation and Opportunity Fund. BASF Pharma and Abbott Laboratories had no role in the design or conduct of the study, collection or analysis of data, or preparation or approval of the manuscript. |
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| Conflict of Interest: AAB currently receives research support from Novartis Pharmaceuticals, Gilead, and Eli Lilly and serves as a contractor for the American College of Cardiology's CardioSource, and previously served on an advisory board for Gilead and as a contractor for Boehringer Ingelheim. RMC currently receives funding from the National Institutes of Health (NIH), National Human Genome Research Institute (U01 HG007269); NIH, National Institute of General Medical Sciences (PEAR, 2U01 GM074492); NIH, National Heart, Lung and Blood Institute (NHLBI) through a contract with Wake Forest University (WHI, HHSN268201100004C); University of Florida Clinical and Translational Science Institute (UF CTSI, Clinical Research Pilot Award); and Southeast Center for Integrative Metabolomics, UF CTSI (Pilot and Feasibility Project Award). EMH reported receiving grant support from NHLBI, Gilead, and educational grants from AstraZeneca, Daiichi Sankyo, Amarin, Mesoblast, ISIS Pharmaceuticals, Esperion Therapeutics, Vessex, Genentech, Cytori, Daiichi-Sankyo, Medtronic, Baxter, United Therapeutics, Sanofi/Aventis, Amgen, and Catabasis. CJP reported receiving research grants from Abbott, Actelion Pharmaceuticals, Amarin, Amgen, Amorcyte, Angioblast/Mesoblast, AstraZeneca, Baxter Healthcare, Brigham and Women's Hospital, Capricor, Inc., Catabasis Pharmaceuticals, Cytori, Daiichi Sankyo, Esperion Therapeutics, Genentech, Gilead, GlaxoSmithKline, InfraReDx Inc., Isis Pharmaceuticals, Lilly, Medtronic, NeoStem Inc., NIH/NHLBI, Regeneron Pharmaceuticals, Sanofi, United Therapeutics Corp; consulting for Lilly/Cleveland Clinic-Data Safety Monitoring Board (DSMB) member for a Phase 2 Efficacy and safety study of Ly2484595, Mesoblast DSMB, Servier, and SLACK Inc. CJP receives support in part from the NIH/NCRR Clinical and Translational Science Award to the University of Florida UL1 TR000064. YG reports that she has no financial disclosures. |
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| Authorship: All authors had access to the data and a substantive role in writing the manuscript. AAB drafted the manuscript, performed research, and analyzed data. All co-authors assisted in writing the manuscript, revised it critically for important intellectual content, and approved the final version of the manuscript and the decision to submit for publication. Additionally, YG analyzed data; RNC designed research and analyzed data; and EMH and CJP designed and performed research. |
Vol 128 - N° 2
P. 137-143 - février 2015 Retour au numéro
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