TOPLINE:
Taking aspirin is associated with slower progression of abdominal aortic aneurysm (AAA), particularly in nonsmokers and men, without an increase in the risk for mortality, major bleeding, and aneurysm dissection or rupture, results of an observational study suggest.
METHODOLOGY:
- The study included 3435 adult patients with an aortic aneurysm (maximal aortic diameter in any dimension ≥ 3.0 cm below kidney arteries) who had at least two vascular ultrasounds and were categorized according to use (defined as at least one filled prescription) or nonuse of aspirin. Mean age was 73.7 years and participants were mostly male (77.5%) and White ( 89.0%).
- Researchers collected data on patient characteristics, aspirin use and dosage, other medications, survival status, and occurrence and time of aneurysm repair, dissection, and rupture, and they obtained abdominal aortic diameter measurements from a vascular ultrasound laboratory database.
- Clinical outcomes included all-cause mortality, major bleeding, aneurysm progression and composite of dissection, rupture, and repair.
TAKEAWAY:
- After a follow-up of up to 10 years, there was no significant difference in all-cause mortality (adjusted hazard ratio [aHR], 0.92; 95% CI, 0.79-1.07; P = .32), major bleeding (aHR, 0.88; 95% CI, 0.76-1.03; P = .12), or composite of aneurysm repair, dissection, or rupture (adjusted sub-hazard ratio, 1.16; 95% CI, 0.93-1.45; P = .09) for patients taking aspirin irrespective of sex or smoking status.
- Patients taking aspirin had a slower mean annualized change in aneurysm diameter compared with patients not taking aspirin (2.8 vs 3.8 mm per year; P = .001).
- When stratified according to smoking status and sex, aspirin use was associated with slower mean annualized change in aneurysm diameter compared with nonuse only among nonsmokers (beta, -0.043; 95% CI, -0.018 to -0.071; P for interaction = .02) and men (beta, -0.039; 95% CI, -0.022 to -0.066; P for interaction = .03).
- Compared with not taking aspirin, aspirin use was associated with lower odds of rapid aneurysm progression, defined as an increase in diameter ≥ 0.5 cm per year, but only among nonsmokers (adjusted odds ratio [aOR], 0.63; 95% CI, 0.45-0.88; P = .008) and men (aOR, 0.64; 95% CI, 0.47-0.87; P = .005).
IN PRACTICE:
The results "provide clear evidence that aspirin use may reduce growth and progression of AAA in select patient populations," the authors write, adding that given the "myriad of data" suggesting a role of platelet activation and inhibition in modulating this disease process, "randomized clinical data are warranted to ascertain the role of aspirin in managing AAA."
SOURCE:
The study was carried out by a team led by Essa Hariri MD, MSc, Department of Internal Medicine, Cleveland Clinic Foundation. It was published online on December 12, 2023 in JAMA Network Open Cardiology.
LIMITATIONS:
This retrospective observational study could not determine causal associations and there may have been selection bias. It was a single-center study, which could limit generalizability of the findings. There was a risk for misclassification of aspirin use, and over-the-counter aspirin use may not have been documented in clinician notes.
DISCLOSURES:
The work was supported by the National Heart Lung and Blood Institute. Hariri has no relevant conflicts of interest; see paper for disclosures of other authors.
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