Aspirin combined with rosuvastatin best combo for CVD prevention

The study found that aspirin combined with rosuvastatin was more effective for preventing individual CVD, including heart attack, angina pectoris, coronary heart disease, and congestive heart failure, than aspirin combined with other statins.

The researchers noted that statins combined with aspirin were advantageous over aspirin alone for CVD prevention. In addition, when considering various ages, sex, and fitness levels, as well as with and without diabetes, the combined use of aspirin and rosuvastatin had the most remarkable effects on CVD prevention than aspirin combined with other statins.

Aspirin is a nonsteroidal anti-inflammatory drug that has been revealed to inhibit the formation of various adhesion molecules and inflammatory mediators, resulting in anti-atherosclerosis. When used for primary CVD prevention, aspirin is reported to lower the risk of major vascular events by 15% to 20%. So, aspirin's role in CVD prevention and treatment is widely acknowledged in the medical community.

Statins are a class of lipid-lowering drugs that substantially impact decreasing lipids and delaying plaque development, thus lowering death and morbidity in individuals with atherosclerotic CVD8. Statin therapy, when used for primary prevention of CVD, has been revealed to reduce the risk of cardiovascular events by 30% to 40%.

It is clear that for the prevention of primary CVD, a combination of statins with aspirin is more beneficial than aspirin alone. However, there needs to be more clarity on the combination of aspirin and statins, which provides the most significant protection against cardiovascular events. Therefore, Tao Liu, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, China, and colleagues investigated which statin type, combined with aspirin, has the best effect for preventing cardiovascular disease using data from the NHANES (National Health and Nutrition Examination Survey) database.

Multivariable logistic regression analysis explored aspirin use and which type of statin is for better CVD preventive effects after adjusting for sociodemographic and standard cardiovascular risk factors. The study included 3778 people from the NHANES from 2011 to 2018. Subsequently, subgroup analyses were carried out.

The authors reported the following findings:

• In the fully-adjusted model, compared to aspirin use alone, the odds ratios for CVD were 0.69, 0.43, 0.44, 0.34 and 0.64 for the combination use of aspirin and lovastatin, atorvastatin, pravastatin, rosuvastatin as well as simvastatin, respectively.
• In combination with rosuvastatin, aspirin was more effective in preventing individual CVD, including coronary heart disease, congestive heart failure, angina pectoris and heart attack, than aspirin combined with other statins.

"Based on the large-scale US general population, our results show that the combined use of aspirin and statins was more effective than aspirin alone in CVD prevention," the researchers wrote. "Moreover, rosuvastatin showed more significant effects in total and individual CVD prevention than other statins combined with aspirin.

Reference:

Liu, T., Zuo, R., Wang, J. et al. Cardiovascular disease preventive effects of aspirin combined with different statins in the United States general population. Sci Rep 13, 4585 (2023). https://doi.org/10.1038/s41598-023-31739-w