Colantonio Lisandro D, Wang Zhixin, Ghazi Lama, Alanaeme Chibuike J, Christenson Ashley, Dubal Medha, Fasokun Mojisola E, Malick Waqas A, Levitan Emily B, Rosenson Robert S, Bittner Vera
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, US.
Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, US.
Eur J Prev Cardiol. 2025 Aug 28. doi: 10.1093/eurjpc/zwaf547.
Small observational studies suggest that aspirin use may be associated with a 50% lower incidence of cardiovascular disease (CVD) in adults with lipoprotein(a) ≥ 50 mg/dL, without apparent benefit in those with lipoprotein(a) < 50 mg/dL. The current study aimed to replicate prior findings in a large, multicohort study.
We analyzed publicly available data from adults without CVD in the ARIC (baseline 1987-1989), CHS (1989-1993), and MESA (2000-2002) studies. High lipoprotein(a) was defined by a mass concentration of ≥50 mg/dL or equivalent. Follow-up for CVD (myocardial infarction, stroke, or CVD death) and coronary heart disease (CHD; myocardial infarction, or CHD death) was available through 2018 in ARIC, 2011 in CHS, and 2015 in MESA. Mixed-effects models were used to obtain pooled results across studies.
Aspirin use in ARIC (n = 13,085), CHS (n = 3,956), and MESA (n = 6,621) was 25.1%, 29.6%, and 19.3%, respectively. Using propensity score matching, the HR (95%CI) for CVD associated with aspirin use among participants with high and low lipoprotein(a) was 1.12 (0.96, 1.31) and 1.04 (0.96, 1.13), respectively (p-value comparing HRs: 0.38). The HR (95%CI) for CHD associated with aspirin use among participants with high and low lipoprotein(a) was 1.01 (0.82, 1.23) and 1.02 (0.92, 1.13), respectively (p-value comparing HRs: 0.94). No evidence of an association of aspirin use with lower CVD risk was present in participants with high or low lipoprotein(a) in subgroup analyses.
There was no evidence to suggest that the association between aspirin and the incidence of CVD may differ by lipoprotein(a) levels.
小型观察性研究表明，对于脂蛋白(a)≥50mg/dL的成年人，使用阿司匹林可能使心血管疾病（CVD）发病率降低50%，而对于脂蛋白(a)<50mg/dL的成年人则无明显益处。本研究旨在通过一项大型多队列研究重现先前的研究结果。
我们分析了动脉粥样硬化风险社区（ARIC，基线时间为1987 - 1989年）、心血管健康研究（CHS，1989 - 1993年）和多族裔动脉粥样硬化研究（MESA，2000 - 2002年）中无CVD的成年人的公开可用数据。高脂蛋白(a)定义为质量浓度≥50mg/dL或等效值。在ARIC研究中对CVD（心肌梗死、中风或CVD死亡）和冠心病（CHD；心肌梗死或CHD死亡）的随访至2018年，在CHS研究中至2011年，在MESA研究中至2015年。使用混合效应模型获得各研究的汇总结果。
ARIC（n = 13,085）、CHS（n = 3,956）和MESA（n = 6,621）中阿司匹林的使用比例分别为25.1%、29.6%和19.3%。采用倾向评分匹配法，脂蛋白(a)高和低的参与者中，使用阿司匹林与CVD相关的HR（95%CI）分别为1.12（0.96，1.31）和1.04（0.96，1.13）（比较HR的p值：0.38）。脂蛋白(a)高和低的参与者中，使用阿司匹林与CHD相关的HR（95%CI）分别为1.01（0.82，1.23）和1.02（0.92，1.13）（比较HR的p值：0.94）。亚组分析中，无论脂蛋白(a)高或低，均未发现使用阿司匹林与较低CVD风险相关的证据。
没有证据表明阿司匹林与CVD发病率之间的关联可能因脂蛋白(a)水平而异。
