Razavi Alexander C, Chen Jing, Yang Wei, Sha Daohang, Dzaye Omar, Bhatia Harpreet S, Tsimikas Sotirios, Lash James P, Kansal Mayank, Rincon-Choles Hernan, Vaccarino Viola, Jacobson Terry A, Budoff Matthew J, Blumenthal Roger S, Whelton Seamus P, Sperling Laurence S, Blaha Michael J, He Jiang
Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, Georgia, USA.
Department of Medicine, University of Texas Southwestern, Dallas, Texas, USA.
JACC Adv. 2025 Aug 19;4(9):102068. doi: 10.1016/j.jacadv.2025.102068.
Chronic kidney disease (CKD) is a risk-enhancing factor for cardiovascular disease (CVD) and is associated with higher lipoprotein(a) (Lp[a]) levels. While aspirin may reduce Lp(a)-related prothrombotic risk, the role of primary prevention aspirin for persons with CKD and elevated Lp(a) is unclear.
The aim of the study was to assess the association of aspirin use with cardiovascular, renal, and bleeding outcomes stratified by Lp(a) level among individuals with CKD without clinical CVD.
There were 2,552 participants without clinical CVD in the Chronic Renal Insufficiency Cohort. Lp(a) was measured at baseline and not reported to clinicians. Aspirin use was self-reported and longitudinally assessed at each follow-up visit. Cox proportional hazards regression assessed the association of aspirin use with myocardial infarction (MI), stroke, end-stage renal disease (ESRD), and major bleeding events, stratified by Lp(a) ≥50 vs <50 mg/dL.
Mean age was 55.8 years, 48% were women, 34% reported aspirin use at baseline, 27% had Lp(a) ≥50 mg/dL, and mean estimated glomerular filtration rate was 47 mL/min/1.73 m. Over a median follow-up of 15.7 years, aspirin use was associated with a 38% lower risk of MI (HR: 0.62; 95% CI: 0.42-0.91) and a 28% lower risk of ESRD (HR: 0.72; 95% CI: 0.59-0.89) among individuals with Lp(a) ≥50 but not Lp(a) < 50 mg/dL (MI, HR: 1.38; 95% CI: 1.07-1.77; ESRD, HR: 0.98; 95% CI: 0.84-1.15). Aspirin use was not significantly associated with stroke or major bleeding in either Lp(a) group.
Individuals with CKD and elevated Lp(a) without clinical CVD may derive net benefit from low-dose aspirin for the primary prevention of MI and ESRD.
慢性肾脏病（CKD）是心血管疾病（CVD）的一个风险增强因素，且与较高的脂蛋白（a）[Lp（a）]水平相关。虽然阿司匹林可能降低与Lp（a）相关的血栓形成风险，但对于患有CKD且Lp（a）升高的患者，一级预防使用阿司匹林的作用尚不清楚。
本研究的目的是评估在无临床CVD的CKD患者中，按Lp（a）水平分层的阿司匹林使用与心血管、肾脏和出血结局之间的关联。
慢性肾功能不全队列中有2552名无临床CVD的参与者。在基线时测量Lp（a），且不向临床医生报告结果。阿司匹林使用情况通过自我报告获得，并在每次随访时进行纵向评估。Cox比例风险回归分析评估了阿司匹林使用与心肌梗死（MI）、中风、终末期肾病（ESRD）和大出血事件之间的关联，按Lp（a）≥50与<50mg/dL分层。
平均年龄为55.8岁，48%为女性，34%在基线时报告使用阿司匹林，27%的Lp（a）≥50mg/dL，平均估计肾小球滤过率为47mL/min/1.73m²。在中位随访15.7年期间，在Lp（a）≥50mg/dL但非Lp（a）<50mg/dL的个体中，使用阿司匹林与MI风险降低38%（HR：0.62；95%CI：0.42-0.91）和ESRD风险降低28%（HR：0.72；95%CI：0.59-0.89）相关（MI，HR：1.38；95%CI：1.07-1.77；ESRD，HR：0.98；95%CI：0.84-1.15）。在任一Lp（a）组中，阿司匹林使用与中风或大出血均无显著关联。
对于无临床CVD但Lp（a）升高的CKD患者，低剂量阿司匹林用于MI和ESRD的一级预防可能带来净获益。
