Aspirin Not Protective Against CVD in Black Patients

Black patients are less likely than white patients to take low-dose aspirin for primary prevention of cardiovascular disease, observational data on more than 65,000 people show. As has previously been shown in earlier studies focused on different populations, though, aspirin didn’t appear to have a protective effect in black individuals.

The drug was once the mainstay of preventive regimens for CVD. But in late 2018, results from three clinical trials—ASPREE, ARRIVE, and ASCEND—made a strong case that the balance of benefit versus bleeding risk tipped toward risk. As such, the 2019 American College of Cardiology/American Heart Association primary prevention guidelines advise a diminished role for aspirin.

However, “no data exist on the role of aspirin therapy in different racial and ethnic groups,” Rodrigo Fernandez-Jimenez, MD, PhD (Icahn School of Medicine at Mount Sinai, New York, NY, and CNIC, Madrid, Spain), and colleagues point out in their paper published online recently in the Journal of the American Heart Association.

Major trials on aspirin for primary prevention didn’t include enough minority participants to enable subgroup analyses by race/ethnicity, they note. Nor is there much information on how patterns in low-dose aspirin use might vary across populations.

“African-Americans have been underrepresented so far in trials [of aspirin]. Although this is an observational study and has a lot of limitations because of the design, [it] tries to address this gap in the literature,” Fernandez-Jimenez told TCTMD.

No Evidence of Benefit

To fill the evidence gap, the researchers turned to the Southern Community Cohort Study, analyzing data on 65,231 non-Hispanic people (average age 51.5 years; 60.1% women) with no history of CVD who enrolled from 2002 to 2009. Median follow-up duration was 11.3 years.

Seven in 10 of participants identified as black and the remainder as white. Two-thirds of the cohort were considered to have a high (≥ 10%) risk of developing CVD over the next 10 years based on Framingham criteria.

Overall, the self-reported prevalence of low-dose aspirin use was 17.1%, spanning from 7.5% in low-risk individuals to 11.6% and 20.4% in intermediate- and high-risk patients, respectively. Black individuals were less apt to take low-dose aspirin than were their white counterparts even when accounting for CVD risk and other potential confounders (adjusted OR 0.79; 95% CI 0.75-0.82).

Across follow-up, low-dose aspirin did not significantly decrease the risk of ischemic cardiac death, though the trend was more positive in white patients (adjusted HR 0.86; 95% CI 0.68-1.10), especially white women (adjusted HR 0.72; 95% CI 0.51-1.02), than in black patients (adjusted HR 1.18; 95% 0.98-1.40). Restricting the analysis to high-risk individuals in their 50s or 60s, for whom the 2016 US Preventive Services Task Force recommendations suggest aspirin might be considered for primary prevention, also showed no benefit.

“Although additional studies are required, these findings provide no evidence of a beneficial effect of aspirin among black patients for CVD primary prevention,” the researchers conclude.