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The Effect of Aspirin on the Primary Prevention of Major Adverse Cardiac and Cerebrovascular Events in Chinese Older Adults: A Registration Study

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Abstract

Background

Low-dose acetylsalicylic acid (aspirin) prevents stroke and myocardial infarction in patients with cardiovascular disease (CVD), but whether it should be used for primary CVD prevention in older Chinese adults remains unclear.

Methods

This prospective study investigated Chinese people aged > 70 years participating in the Kadoorie Study of Chronic Disease. The subjects were grouped as aspirin users and nonusers. Propensity score matching (PSM) was used to achieve balanced baseline characteristics. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE). The secondary outcomes were all-cause mortality, cardiovascular and/or cerebrovascular disease (CCVD) mortality, and bleeding events. Survival curves were used to compare the outcomes between groups. Cox regression was used to identify the risk factors for the outcomes.

Results

In total, 4791 participants were categorized as aspirin users (n = 257) or nonusers (n = 4534). PSM resulted in 252 and 951 participants in the aspirin user and nonuser groups, respectively. Median follow-up was 8.6 years. Aspirin did not influence MACCE, all-cause mortality, or bleeding events, but it did influence CCVD deaths (p = 0.019). Male sex (hazard ratio [HR] 1.652; 95% confidence interval [CI] 1.217–2.243; p = 0.001), body mass index (BMI) (HR 1.053; 95% CI 1.008–1.100; p = 0.021), and systolic blood pressure (HR 1.009; 95% CI 1.003–1.016; p = 0.004) were independent risk factors for MACCE. Survival analysis showed higher rates of CCVD mortality among aspirin users (HR 1.363; 95% CI 1.040–1.786; p = 0.025), but this was not significant in the regression analysis.

Conclusions

There were no significant benefits from using aspirin as primary prevention for MACCE in older Chinese adults.

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Acknowledgements

The authors thank the staff of the Chinese Center for Disease Control and Prevention, the Chinese Ministry of Health, the National Health and Family Planning Commission of China, and ten regional Health Administrative Departments. Most importantly, we are grateful to the study subjects for their participation and the project development and management teams based in Beijing, Oxford, and the ten regional research centers.

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Authors and Affiliations

  1. Department of Neurology, First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang, China

    Xiaojia Sun, Ruihong Sun & Liming Zhang

Authors
  1. Xiaojia Sun
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  2. Ruihong Sun
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  3. Liming Zhang
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Corresponding author

Correspondence to Xiaojia Sun.

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Funding

This study was funded by the National Key Research and Development Program of China (Grant numbers 2016YFC0900500, 2016YFC0900501, 2016YFC0900504), the Kadoorie Charitable Foundation in Hong Kong, and the Wellcome Trust in the UK (Grant numbers 202922/Z/16/Z, 088158/Z/09/Z, 104085/Z/14/Z).

Conflicts of Interest

Xiaojia Sun, Ruihong Sun, and Liming Zhang have no conflicts of interest that are directly relevant to the content of this article.

Availability of data and material

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code availability

Not applicable.

Author Contributions

Xiaojia Sun and Ruihong Sun contributed to the conception. Liming Zhang contributed to the design of the work. Xiaojia Sun contributed to the acquisition, analysis, and interpretation of data for the work. Ruihong Sun contributed to interpretation. Liming Zhang contributed to the acquisition. Xiaojia Sun drafted the manuscript. Ruihong Sun and Liming Zhang critically revised the manuscript. All authors read and approved the final manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work, ensuring integrity and accuracy.

Ethics approval

This study was performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. It was approved by the Chinese Center for Disease Control and Prevention Ethical Review Committee (No. 005/2004). Written informed consent was obtained from all participants from CKB.

Consent to participate

Written informed consent was obtained from the patients to publish this paper.

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Not applicable.

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Sun, X., Sun, R. & Zhang, L. The Effect of Aspirin on the Primary Prevention of Major Adverse Cardiac and Cerebrovascular Events in Chinese Older Adults: A Registration Study. Drugs Aging 39, 97–106 (2022). https://doi.org/10.1007/s40266-021-00906-x

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