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Aspirin and cardiovascular primary prevention in non-endstage chronic kidney disease: A meta-analysis.

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journal contribution
posted on 30.08.2016, 14:51 by Rupert W. Major, Issaam Oozeerally, Simon Dawson, Helen Riddleston, Laura J. Gray, Nigel J. Brunskill
BACKGROUND AND AIMS: Chronic kidney disease is a strong independent predictor of cardiovascular disease. No published meta-analyses on the use of aspirin for the primary prevention of cardiovascular disease in chronic kidney disease exist. We therefore performed a systematic review and meta-analysis of this subject. METHODS: We used a pre-defined and registered protocol (PROSPERO identification CRD42014008860). We searched Medline and Embase between 1996 and July 2015. Inclusion criteria were adult subjects with non-endstage chronic kidney disease (CKD) and no history of cardiovascular disease. The co-primary outcomes were major cardiovascular events and all-cause mortality. Secondary outcomes included bleeding-related events. We used a random effects model to pool data. RESULTS: Three trials were identified and two of these provided previously unpublished data. The studies included 4468 participants and 16,740 person-years of follow-up. There were no statistically significant reductions in the risk of major cardiovascular events (RR 0.92, 95% CI 0.49 to 1.73, p = 0.79, I(2) 71%) or mortality (RR 0.74, 95% CI 0.55 to 1.00, p = 0.05, I(2) 0%) with aspirin compared to the control group. Major bleeding events were increased with aspirin though (RR 1.98, 95% CI 1.11 to 3.52, p = 0.02, I(2) 0%). CONCLUSIONS: There is no clear benefit of aspirin for the primary prevention of cardiovascular events in CKD and no statistically significant reduction in mortality. Aspirin is likely to increase the risk of major bleeding events. Currently, insufficient randomised control trial data exists to recommend universal use or avoidance of aspirin for primary prevention of cardiovascular events in CKD.

History

Citation

Atherosclerosis, 2016, 251, pp. 177-182

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Health Sciences

Version

AM (Accepted Manuscript)

Published in

Atherosclerosis

Publisher

Elsevier

issn

0021-9150

eissn

1879-1484

Acceptance date

08/06/2016

Copyright date

2016

Available date

10/06/2017

Publisher version

http://www.sciencedirect.com/science/article/pii/S0021915016302581

Notes

The file associated with this record is under a 12 month embargo from publication in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en