Aspirin discontinuation in CVD prevention is associated with increased CV risk
Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort StudyLiterature - Sundström J, Hedberg J, Thuresson M, et al. - Circulation. 2017;136:1183-1192
- During a median of 3.0 years of follow-up (range: 0.002–3.5 years), corresponding to 1 491 369 person-years (PY) at risk, 62 690 CV events occurred (incidence rate: 42.0 per 1000 PY at risk). 19 978 PY were excluded from the analyses because of surgical procedures and major bleeding events.
- Patients on persistent aspirin treatment had the lowest incidence of CV events. Patients who had discontinued aspirin had a 37% higher rate of CV events, corresponding to an absolute risk increase of 13.5 events per 1000 PY at risk. On average, 1 of every 74 patients who discontinued aspirin had an additional CV event in 1 year.
- In patients receiving aspirin for secondary prevention, discontinuing aspirin was associated with a 46% higher rate of CV events than continuing on aspirin, corresponding to an absolute risk increase of 28.0 per 1000 PY at risk, or an additional CV event per year in 1 of every 36 patients who discontinued aspirin.
- In patients who were probably using aspirin for primary prevention, discontinuing aspirin was associated with a 28% higher rate of CV events than continuing on aspirin, an absolute risk increase of 6.9 per 1000 PY at risk, or an additional CV event per year in 1 of every 146 patients who discontinued aspirin.
- Patients who stopped taking aspirin after a period of 4 timely dispenses had an early risk increase for CV events compared with those who collected their fifth dispense on time. The median time to the first CV event in those who did not collect their fifth dispense on time was one-third the time of those who collected their dispense on schedule (time ratio: 0.31; 95% CI: 0.22–0.43).
The discontinuation of low-dose long-term aspirin use for CVD prevention in the absence of major surgery or bleeding, was associated with a >30% increased CV risk, shortly after discontinuation. These findings support the use of aspirin in CVD prevention, and justifies further measures to ensure treatment persistence in this setting.