Aspirin and Cardiovascular Risk in Individuals With Elevated Lipoprotein(a): The Multi-Ethnic Study of Atherosclerosis.
Level 3 - non-randomized controlled study
Propensity score-matched prospective cohort study
PubMed 38293935 · doi:10.1161/JAHA.123.033562
What was done
Researchers analyzed data from the prospective Multi-Ethnic Study of Atherosclerosis (MESA) cohort among individuals free of baseline cardiovascular disease. Aspirin users were matched to nonusers using propensity scores based on cardiovascular disease (CVD) risk factors. The association between aspirin use and coronary heart disease (CHD) events (CHD death, nonfatal myocardial infarction) was evaluated stratified by baseline lipoprotein(a) levels (cutoff of 50 mg/dL) using multivariable Cox proportional hazards models.
What was found
After propensity matching, 2,183 participants were analyzed, of whom 1,234 (57%) used aspirin at baseline and 423 (19%) had lipoprotein(a) >50 mg/dL. Participants with lipoprotein(a) >50 mg/dL had higher incident CHD event rates than those with <=50 mg/dL (13.7% vs 8.9%, P < 0.01) and more baseline aspirin use (61.7% vs 55.3%, P = 0.02). Among participants with lipoprotein(a) >50 mg/dL, aspirin use was associated with significantly fewer CHD events (hazard ratio, 0.54 [95% CI, 0.32-0.94]; P = 0.03), bringing their risk down to a level similar to participants with lipoprotein(a) <=50 mg/dL regardless of aspirin use.
Why it matters
Elevated lipoprotein(a) lacks targeted primary prevention therapies; these findings suggest that aspirin may reduce atherothrombotic risk in this high-risk population.
Limits
The study is observational and prone to residual confounding by indication despite propensity score matching. Bleeding risks, specific aspirin dosing, and adherence changes over time were not reported in the abstract, and the subgroup with elevated lipoprotein(a) was relatively small (n = 423).
Cited by
- supports Taking baby aspirin has been shown to offer cardiovascular benefits in people who have elevated levels of lipoprotein(a).