Primary Prevention Aspirin, Lipoprotein(a), and Cardiorenal Outcomes in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort.

BACKGROUND

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.

OBJECTIVES

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.

METHODS

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.

RESULTS

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 m2. 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.

CONCLUSIONS

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.