Evidence map›Paper›PMID 28947478›Full record

ArticleCirculation2017

Low-Dose Aspirin Discontinuation and Risk of Cardiovascular Events: A Swedish Nationwide, Population-Based Cohort Study.

Johan Sundström, Jakob Hedberg, Marcus Thuresson, Pernilla Aarskog, Kasper Munk Johannesen, Jonas Oldgren

Open access · bronzeAbstract read
PubMed Publisher
In one paragraph

Article in Circulation, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 52 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
52citing papers in PubMed, 2 pooled it
11.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

52 citing papers in PubMed, 2 syntheses or guidelines pooled it, 135 citations in OpenAlex.

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  19. Aspirin use for primary prevention in older adults.Journal of the American Geriatrics Society · 2023
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Johan SundströmFrom Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.). Johan.Sundstrom@medsci.uu.se.
Jakob HedbergFrom Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).
Marcus ThuressonFrom Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).
Pernilla AarskogFrom Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).
Kasper Munk JohannesenFrom Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).
Jonas OldgrenFrom Department of Medical Sciences (J.S., J.O.), Uppsala Clinical Research Center (J.S., J.O.), and Department of Surgical Sciences (J.H), Uppsala University, Sweden; Statisticon AB, Uppsala, Sweden (M.T.); AstraZeneca Nordic Baltic, Södertälje, Sweden (P.A.); and Linköping University, Sweden (K.M.J.).
Statisticon (Sweden) · SE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere are increasing concerns about risks associated with aspirin discontinuation in the absence of major surgery or bleeding. We investigated whether long-term low-dose aspirin discontinuation and treatment gaps increase the risk of cardiovascular events.

methodsWe performed a cohort study of 601 527 users of low-dose aspirin for primary or secondary prevention in the Swedish prescription register between 2005 and 2009 who were >40 years of age, were free from previous cancer, and had ≥80% adherence during the first observed year of treatment. Cardiovascular events were identified with the Swedish inpatient and cause-of-death registers. The first 3 months after a major bleeding or surgical procedure were excluded from the time at risk.

resultsDuring a median of 3.0 years of follow-up, 62 690 cardiovascular events occurred. Patients who discontinued aspirin had a higher rate of cardiovascular events than those who continued (multivariable-adjusted hazard ratio, 1.37; 95% confidence interval, 1.34-1.41), corresponding to an additional cardiovascular event observed per year in 1 of every 74 patients who discontinue aspirin. The risk increased shortly after discontinuation and did not appear to diminish over time.

conclusionsIn long-term users, discontinuation of low-dose aspirin in the absence of major surgery or bleeding was associated with a >30% increased risk of cardiovascular events. Adherence to low-dose aspirin treatment in the absence of major surgery or bleeding is likely an important treatment goal.

Indexed as

AgedAged, 80 and overAnti-Inflammatory Agents, Non-SteroidalAspirinCardiovascular DiseasesCohort StudiesFemaleFollow-Up StudiesHumansIncidenceMaleMedication AdherenceMiddle AgedProportional Hazards ModelsRiskSwedenAnti-Inflammatory Agents, Non-SteroidalAspirinaspirincohort studiesprimary preventionsecondary prevention

Identifiers

PMID28947478
OpenAlexW2758771548

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.