Aspirin does not reduce risk of CV events or mortality in people with family history of premature MI

A family history of premature CVD is a significant risk enhancer for the occurrence of CV events. While a family history of CVD is conceptually simple, it results from a complex interplay between genetics and environment, as siblings and parents share a genetic predisposition and lifestyle behaviours that can raise the risk. Aspirin's role in this population is still controversial. Current recommendations consider aspirin only in people with a higher baseline risk of cardiovascular disease, in which the putative benefits would eventually outweigh the known risk of bleeding.

Against the above background, Daniel Caldeira and the research team from Portugal conducted a retrospective analysis of the VITAL trial cohort to examine the association between parental history of premature MI and aspirin exposure with improved CV outcomes.

The VITAL trial included 25,871 participants; they were randomly assigned vitamin D3 (cholecalciferol) 2,000 IU per day or placebo and omega-3 fatty acids 1 g per day or placebo for preventing major CV events and invasive cancer of any type.

The findings from the trial showed that neither omega-3 nor vitamin D3 supplements for primary prevention lowered major CV events or development of invasive cancers than placebo at five years, but some secondary endpoints showed good signals.

The key points of the study are as follows:

• Among the 22,915 VITAL participants who reported data regarding a family history of premature MI, 3,653 had a family history of premature MI, and 19,262 did not.
• Participants with a family history of premature MI in VITAL were younger (66.7 vs. 66.03 years) and less likely to be women (51% vs. 46%) than those without a family history.
• Those with a family history of premature MI were more likely to have risk factors such as hypertension (48% vs. 54%) and diabetes (13% vs. 16%).
• Participants with a parental history of premature MI were more often prescribed statins (34% vs. 41%) or aspirin (45% vs. 51%) compared with participants without a family history.
• History of premature parental MI was associated with more significant overall mortality (HR = 1.33) and major adverse CV events (HR = 1.31) compared with no history.
• In participants with a family history of premature MI, aspirin use was not associated with a significant decrease in overall mortality (HR = 0.77), major adverse CV events (HR = 0.81) or any secondary outcomes, including CV mortality, CHD, stroke and expanded significant adverse CV events.

"Regarding aspirin use in primary prevention, there was no significant association between this drug exposure and CV outcomes or all-cause mortality reduction," the researchers concluded.

Reference:

Daniel Caldeira, Miguel Marques Antunes, Mariana Alves, Fausto J Pinto, Family history of premature myocardial infarction and the effect of aspirin, European Journal of Preventive Cardiology, 2022;, zwac295, https://doi.org/10.1093/eurjpc/zwac295