To determine whether or not aspirin added on top of statins is beneficial in reducing cardiovascular mortality, we analyzed data of hypertensive patients selected from the Korea National Health Insurance sample cohort.Design and Method:
Among the 758,433 eligible subjects aged 20 years or older in 2005, 36,918 subjects were selected for final analysis and divided into four groups. 1) No treatment group (N = 25,133); 2) Aspirin alone group(N = 4,865); 3) Statin alone group (N = 4,943); 4) Combination treatment group (N = 1,977). The mean follow-up duration was 93 ± 13 months. The primary outcome of the study was all-cause and cardiovascular mortality from 2007 to 2013.Results:
Treatment with aspirin alone (HR, 0.61; 95% CI, 0.54–0.69; p < 0.001), treatment with statin alone (HR, 0.45; 95% CI, 0.39–0.53; p < 0.001) and combination treatment (HR, 0.42; 95% CI, 0.33–0.54; p < 0.001) were independently associated with reduction in all-cause mortality. Also, treatment with aspirin alone (HR, 0.66; 95% CI, 0.52–0.83; p < 0.001), treatment with statin alone (HR, 0.43; 95% CI, 0.31–0.60; p < 0.001) and combination treatment (HR, 0.48; 95% CI, 0.31–0.77; p = 0.002) were independently associated with reduction in cardiovascular mortality as well. Addition of aspirin to statins was not associated with additive benefit in reducing total mortality and cardiovascular mortality.Conclusions:
Primary prevention with aspirin and statins are beneficial for reducing both all cause and cardiovascular mortality reduction in hypertensive subjects. However, as aspirin administration is associated with increased risk of major bleeding, care must be taken to assess the risk benefit of using aspirin in primary prevention.