Aspirin use is not associated with primary prevention of all-cause, cardiovascular, or oncologic mortality.(Report)

Abstract

Introduction: The role of aspirin in the primary prevention of cardiovascular (CV) disease is controversial, with the FDA recently rejecting a request to market aspirin for primary prevention of heart disease citing too little data showing clear benefit. Few studies have found mortality benefit for using aspirin in primary prevention of CV disease, with some studies showing potential for harm as well. Studies have also suggested that aspirin use may reduce oncologic mortality.

Hypothesis: We tested the hypothesis that aspirin use is significantly associated with all-cause, CV, and oncologic mortality.

Methods: Using the National Health and Nutrition Examination Survey (NHANES III), we examined the association of aspirin use and all-cause, CV, and oncologic mortality within 15,968 individuals. After weighting, we used propensity score matching within participants using an optimal 1:4 matching technique to control for age, low density lipoprotein cholesterol, glomerular filtration rate, race, gender, use of cholesterol lowering medication, diabetes mellitus, high density lipoprotein, hypertension, elevated waist circumference, low socioeconomic status, and smoking. We excluded those with pre-existing heart disease or missing information on aspirin use. All-cause, CV and oncologic mortality were assessed after a mean of 14.0 (+/- 0.22) year follow-up.

Results: After matching there were 775 aspirin users matched with 3,100 non-aspirin users. There were no significant differences between both groups with respect to all-cause mortality (P=1.09, 95% CI 0.82-1.45), CV mortality (P=1.14, 95% CI 0.78-1.67), or oncologic mortality (P=1.04, 95% CI 0.68-1.59).

Conclusions: This study shows similar mortality outcomes between aspirin users and non-users for all-cause, CV, and oncologic mortality within a nationally representative sample adding additional evidence that aspirin does not have a clear role in primary prevention of disease.