Efficacy of aspirin and statins in primary prevention of cardiovascular mortality in uncomplicated hypertensive participants: a Korean national cohort study

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To determine whether the addition of aspirin to a statin regimen is beneficial in reducing cardiovascular mortality, we analyzed data for uncomplicated hypertensive patients included in the Korea National Health Insurance sample cohort.


Among the 758 433 eligible participants aged 20 years or older in 2005, 31 115 participants were selected and divided into four groups: no-treatment group (N = 19 628); aspirin alone group (N = 4814); statins alone group (N = 4717); and combined treatment group (N = 1956). The mean follow-up duration was 94 ± 13 months. The primary outcome of the study was all-cause and cardiovascular mortality from 2007 to 2013.


Treatment with aspirin alone [hazard ratio (HR), 0.62; 95% confidence interval (CI), 0.55–0.70; P < 0.001), treatment with statins alone (HR, 0.48; 95% CI, 0.41–0.57; P < 0.001), and combined treatment (HR, 0.43; 95% CI, 0.34–0.55; P < 0.001) were independently associated with reductions in all-cause mortality. Treatment with aspirin alone (HR, 0.66; 95% CI, 0.53–0.84; P < 0.001), treatment with statins alone (HR, 0.46; 95% CI, 0.33–0.64; P < 0.001), and combined treatment (HR, 0.50; 95% CI, 0.31–0.79; P = 0.003) were also independently associated with reductions in cardiovascular mortality. The addition of aspirin to statins was not associated with an additive benefit in reducing total mortality or cardiovascular mortality.


Primary prevention with aspirin and/or statins is beneficial in reducing both all-cause and cardiovascular mortality in uncomplicated hypertensive participants. Nevertheless, as aspirin administration is associated with an increased risk of major bleeding, care must be taken to assess the risk/benefit of using aspirin in primary prevention.

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