Aspirin does not cut risk in non-obstructive coronary artery disease,
study finds
Date:
April 28, 2022
Source:
Radiological Society of North America
Summary:
Aspirin therapy, as opposed to statin use, for non-obstructive
coronary artery disease does not reduce major cardiovascular events,
according to a new study.
FULL STORY ========================================================================== Aspirin therapy, as opposed to statin use, for non-obstructive coronary
artery disease does not reduce major cardiovascular events, according
to a new study published in the journal Radiology: Cardiothoracic Imaging.
========================================================================== Coronary artery disease is the most common type of heart disease,
affecting roughly 6.7% of U.S. adults, according to the Centers for
Disease Control and Prevention. Coronary artery disease occurs when
there is a buildup of plaque in the arteries that supply blood to the
heart. Coronary artery disease puts people at a higher risk for major
adverse cardiovascular events, including heart attack and death.
Non-obstructive coronary artery disease occurs when there is less than 50% stenosis, or narrowing, of the coronary arteries due to plaque buildup.
Coronary CT angiography (CCTA) is often recommended as a first-line test
to detect plaque.
Medications called statins are commonly prescribed for patients who
are diagnosed with non-obstructive coronary artery disease. Statins
reduce the production of low-density lipoprotein (LDL) cholesterol
and draw cholesterol out of plaque, therefore stabilizing the plaque
and reducing the risk of it rupturing. Aspirin is another drug that
is commonly recommended. However, not much research has been done to
determine whether aspirin is effective at reducing major cardiovascular
events in patients with non-obstructive coronary artery disease.
"While observational in nature, our data calls into question the value
of initiating aspirin therapy following the diagnosis of non-obstructive coronary artery disease on a coronary CT angiography," said study author Jonathan Leipsic, M.D., professor and head of the Department of Radiology
at the University of British Columbia in Vancouver, Canada.
For the study, researchers used data from the CONFIRM (COronary
CT Angiography EvaluatioN For Clinical Outcomes: An InteRnational
Multicenter) registry, a large, multinational database of patients who
have undergone CCTA. A total of 6,386 patients (mean age 56.0 years,
52% men) who had either no detectable coronary plaque or non-obstructive coronary artery disease were selected.
Patients with obstructive coronary artery disease that had 50% or greater stenosis were excluded. The mean follow-up period for selected patients
was 5.7 years.
A total of 3,571 (56%) of the patients included in the study
had no plaque and 2,815 (44%) had non-obstructive coronary artery
disease. Non-obstructive coronary artery disease was associated with a
10.6% risk of all-cause mortality compared to 4.8% in patients without
plaque.
Baseline aspirin and statin use were documented for both groups. In
individuals with nonobstructive coronary artery disease, aspirin therapy
was not associated with a reduction in major adverse cardiovascular
events. Alternatively, statin use was associated with a significant
reduction in cardiovascular events, including heart attack and death.
"Our findings build on prior analyses from the CONFIRM registry at
2.3-year follow-up which called into question the utility of aspirin in
the setting of CCTA diagnosed atherosclerosis," Dr. Leipsic said.
Neither aspirin nor statin therapy improved clinical outcomes for patients
with no detectable plaque. Aspirin therapy may still be beneficial in
cases of high- risk plaque or high plaque burden, Dr. Leipsic said.
"Ultimately, further research is required to determine whether, and
at what threshold, clinicians should consider prescribing aspirin for
patients upon the identification of non-obstructive coronary artery
disease on coronary CT angiography," he said.
========================================================================== Story Source: Materials provided by
Radiological_Society_of_North_America. Note: Content may be edited for
style and length.
========================================================================== Journal References:
1. Praveen Indraratna, Christopher Naoum, Sagit Ben Zekry, Heidi
Gransar,
Philipp Blanke, Stephanie Sellers, Stephan Achenbach, Mouaz
H. Al-Mallah, Daniele Andreini, Daniel S. Berman, Matthew J. Budoff,
Filippo Cademartiri, Tracy Q. Callister, Hyuk-Jae Chang, Kavitha
Chinnaiyan, Benjamin J. W. Chow, Ricardo C. Cury, Augustin DeLago,
Gudrun Feuchtner, Martin Hadamitzky, Joerg Hausleiter, Philipp
A. Kaufmann, Yong‐Jin Kim, Erica Maffei, Hugo Marques,
Pedro de Arau'jo Gonc,alves, Gianluca Pontone, Gilbert L. Raff,
Ronen Rubinshtein, Todd C. Villines, Fay Y.
Lin, Leslee J. Shaw, Jagat Narula, Jeroen J. Bax, Jonathon
A. Leipsic.
Aspirin and Statin Therapy for Nonobstructive Coronary Artery
Disease: Five-year Outcomes from the CONFIRM Registry. Radiology:
Cardiothoracic Imaging, 2022; 4 (2) DOI: 10.1148/ryct.210225
2. Arzu Canan, Ann Marie Navar. Limitations of Observational Studies
for
Aspirin in Primary Prevention and the Need for Randomized Trials.
Radiology: Cardiothoracic Imaging, 2022; 4 (2) DOI:
10.1148/ryct.220079 ==========================================================================
Link to news story:
https://www.sciencedaily.com/releases/2022/04/220428103941.htm
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