Aspirin prevents CVD in older adults with elevated lipoprotein(a) genotypes

Use of aspirin offers health benefits to older individuals with elevated lipoprotein(a) genotypes by preventing cardiovascular events, suggests a study.

A total of 12,815 genotyped individuals aged ≥70 years of European ancestry and without prior cardiovascular disease (CVD) events enrolled in the ASPREE trial of 100 mg/d aspirin were included in this study. Lipoprotein(a)-associated genotypes were defined using rs3798220-C carrier status and quintiles of a lipoprotein(a) genomic risk score (LPA-GRS).

The researchers then tested for interaction between genotypes and aspirin allocation in Cox proportional hazards models for incidence of major adverse cardiovascular events (MACE) and clinically significant bleeding. They also explored the association in the aspirin and placebo arms separately.

Some 435 MACE occurred during a median follow-up of 4.7 years. An interaction was noted between rs3798220-C and aspirin allocation (p=0.049); rs3798220-C carrier status correlated with a higher MACE risk in the placebo group (hazard ratio [HR], 1.90, 95 percent confidence interval [CI], 1.11‒3.24), but not in the aspirin group (HR, 0.54, 95 percent CI, 0.17‒1.70).

High LPA-GRS also correlated with an increased MACE risk in the placebo group (HR, 1.70, 95 percent CI, 1.14‒2.55), but this risk was slightly lower in the aspirin group (HR, 1.41, 95 percent CI, 0.90‒2.23). However, the interaction did not reach statistical significance.

In addition, aspirin reduced MACE by 1.7 events per 1,000 person-years and increased clinically significant bleeding by 1.7 events per 1,000 person-years in all participants. In the rs3798220-C and high LPA-GRS subgroups, aspirin reduced MACE by 11.4 and 3.3 events per 1,000 person-years, respectively, with no significant increase in bleeding risk.