Article

In secondary cardiovascular prevention, discontinuation of
acetylsalicylic acid (ASA) is associated with an increased risk of cardiovascular
events. This study assessed the impact of ASA reinitiation on the risk of
myocardial infarction and coronary heart disease death. METHODS: Patients
prescribed ASA for secondary cardiovascular prevention and who had had a period
of ASA discontinuation of >/=90 days in 2000-2007 were identified from The Health
Improvement Network (N = 10,453). Incidence of myocardial infarction/coronary
heart disease death was calculated. Survival analyses using adjusted Cox
proportional hazard models were performed to calculate hazard ratios and 95%
confidence intervals for the risk of myocardial infarction/coronary heart disease
death associated with ASA use patterns after the initial period of
discontinuation. Individuals who were prescribed ASA during follow-up were
considered reinitiators. RESULTS: The incidence of myocardial infarction/coronary
heart disease death was 8.90 cases per 1000 person-years. Risk of myocardial
infarction/coronary heart disease death was similar for current ASA users, who
had been continuously exposed since reinitiation, and patients who had not
reinitiated ASA (hazard ratio 1.27, 95% confidence interval 0.93-1.73). Among
reinitiators, an additional period of ASA discontinuation was associated with
increased risk of myocardial infarction/coronary heart disease death compared
with no reinitiation (current users: hazard ratio 1.46, 95% confidence interval
1.13-1.90; noncurrent users: hazard ratio 1.70, 95% confidence interval
1.31-2.21). CONCLUSIONS:
ASA reinitiation was not associated with a decreased
risk of myocardial infarction/coronary heart disease death. This may be explained
by confounding by indication/comorbidity, whereby higher-risk patients are more
likely to reinitiate therapy. An additional period of ASA discontinuation among
reinitiators was associated with an increased risk of myocardial
infarction/coronary heart disease death.
CI - (c) The European Society of Cardiology 2015.

Langue : ANGLAIS