Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials
Abstract Background Chronic kidney disease (CKD) is a global health concern and an independent risk factor for cardiovascular disease. Despite optimal treatments, mortality remains high among CKD patients. This meta-analysis aimed to assess the balance between the cardiovascular benefits and the ble...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2025-04-01
|
| Series: | BMC Cardiovascular Disorders |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12872-024-04354-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849733426126520320 |
|---|---|
| author | Jingwen Lin Xueqiong Cao Wu Fu Liu Yang Wanxian Zeng Na Li Maobai Liu Hongfu Cai |
| author_facet | Jingwen Lin Xueqiong Cao Wu Fu Liu Yang Wanxian Zeng Na Li Maobai Liu Hongfu Cai |
| author_sort | Jingwen Lin |
| collection | DOAJ |
| description | Abstract Background Chronic kidney disease (CKD) is a global health concern and an independent risk factor for cardiovascular disease. Despite optimal treatments, mortality remains high among CKD patients. This meta-analysis aimed to assess the balance between the cardiovascular benefits and the bleeding risks associated with the use of low-dose aspirin in patients with CKD stages 3–5. Methods Randomized controlled trials (RCTs) regarding the use of low-dose aspirin for cardiovascular primary prevention for patients with CKD were searched in PubMed, Embase, and the Cochrane Library. The Cochrane Collaboration RoB 2.0 tool was used to assess the risk of bias of RCTs. Major adverse cardiovascular events (MACE), including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke, along with other related outcomes, was calculated using a random-effects model to determine hazard ratios and relative risks (RRs). A subgroup analysis was stratified by estimated glomerular filtration rate (eGFR) levels to assess the differential effects of the treatment on patients with varying degrees of kidney function impairment. Results Five long-term RCTs were identified through systematic searches. Among them, 2 were at low risk, 2 had bias concerns, and 1 was at high risk. Aspirin significantly reduced the risk of MACE (RR, 0.76; 95% CI, 0.62–0.94), cardiovascular mortality (RR, 0.60; 95% CI, 0.43–0.85) and all-cause mortality (RR, 0.78; 95% CI, 0.63–0.96) in patients with CKD stages 3–5 compared to those not taking aspirin. When eGFR < 45 mL/min per 1.73 m2, the use of aspirin was associated with a significant reduction in the risk of myocardial infarction (RR, 0.47; 95% CI, 0.23–0.96) and cardiovascular mortality (RR, 0.47; 95% CI, 0.24–0.92). However, aspirin increased the risk of major bleeding in patients with CKD stages 3–5 compared to those not taking aspirin (RR, 1.50; 95% CI, 1.12, 2.02). Conclusions Low-dose aspirin provided significant benefits in preventing MACE, cardiovascular mortality and all-cause mortality in patients with CKD stages 3–5, particularly in preventing myocardial infarction, and cardiovascular mortality in those with an eGFR < 45 mL/min per 1.73 m2. However, the risk of major bleeding tended to increase as the eGFR decreased. For patient populations with a high risk of bleeding, it is necessary to re-evaluate the appropriateness of aspirin use. |
| format | Article |
| id | doaj-art-5fd42dbbef8a40bfaba124f643a8930b |
| institution | DOAJ |
| issn | 1471-2261 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj-art-5fd42dbbef8a40bfaba124f643a8930b2025-08-20T03:08:02ZengBMCBMC Cardiovascular Disorders1471-22612025-04-0125111010.1186/s12872-024-04354-4Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trialsJingwen Lin0Xueqiong Cao1Wu Fu2Liu Yang3Wanxian Zeng4Na Li5Maobai Liu6Hongfu Cai7Department of Pharmacy, Fujian Medical University Union HospitalThe School of Pharmacy, Fujian Medical UniversityThe School of Pharmacy, Fujian Medical UniversityThe School of Pharmacy, Fujian Medical UniversityThe School of Pharmacy, Fujian Medical UniversityDepartment of Pharmacy, Fujian Medical University Union HospitalDepartment of Pharmacy, Fujian Medical University Union HospitalDepartment of Pharmacy, Fujian Medical University Union HospitalAbstract Background Chronic kidney disease (CKD) is a global health concern and an independent risk factor for cardiovascular disease. Despite optimal treatments, mortality remains high among CKD patients. This meta-analysis aimed to assess the balance between the cardiovascular benefits and the bleeding risks associated with the use of low-dose aspirin in patients with CKD stages 3–5. Methods Randomized controlled trials (RCTs) regarding the use of low-dose aspirin for cardiovascular primary prevention for patients with CKD were searched in PubMed, Embase, and the Cochrane Library. The Cochrane Collaboration RoB 2.0 tool was used to assess the risk of bias of RCTs. Major adverse cardiovascular events (MACE), including cardiovascular mortality, nonfatal myocardial infarction, and nonfatal stroke, along with other related outcomes, was calculated using a random-effects model to determine hazard ratios and relative risks (RRs). A subgroup analysis was stratified by estimated glomerular filtration rate (eGFR) levels to assess the differential effects of the treatment on patients with varying degrees of kidney function impairment. Results Five long-term RCTs were identified through systematic searches. Among them, 2 were at low risk, 2 had bias concerns, and 1 was at high risk. Aspirin significantly reduced the risk of MACE (RR, 0.76; 95% CI, 0.62–0.94), cardiovascular mortality (RR, 0.60; 95% CI, 0.43–0.85) and all-cause mortality (RR, 0.78; 95% CI, 0.63–0.96) in patients with CKD stages 3–5 compared to those not taking aspirin. When eGFR < 45 mL/min per 1.73 m2, the use of aspirin was associated with a significant reduction in the risk of myocardial infarction (RR, 0.47; 95% CI, 0.23–0.96) and cardiovascular mortality (RR, 0.47; 95% CI, 0.24–0.92). However, aspirin increased the risk of major bleeding in patients with CKD stages 3–5 compared to those not taking aspirin (RR, 1.50; 95% CI, 1.12, 2.02). Conclusions Low-dose aspirin provided significant benefits in preventing MACE, cardiovascular mortality and all-cause mortality in patients with CKD stages 3–5, particularly in preventing myocardial infarction, and cardiovascular mortality in those with an eGFR < 45 mL/min per 1.73 m2. However, the risk of major bleeding tended to increase as the eGFR decreased. For patient populations with a high risk of bleeding, it is necessary to re-evaluate the appropriateness of aspirin use.https://doi.org/10.1186/s12872-024-04354-4AspirinMajor adverse cardiovascular eventsChronic kidney diseaseMortality |
| spellingShingle | Jingwen Lin Xueqiong Cao Wu Fu Liu Yang Wanxian Zeng Na Li Maobai Liu Hongfu Cai Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials BMC Cardiovascular Disorders Aspirin Major adverse cardiovascular events Chronic kidney disease Mortality |
| title | Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials |
| title_full | Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials |
| title_fullStr | Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials |
| title_full_unstemmed | Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials |
| title_short | Effect of low-dose aspirin on reducing cardiovascular events and mortality in individuals with CKD stages 3–5: a meta-analysis of randomized controlled trials |
| title_sort | effect of low dose aspirin on reducing cardiovascular events and mortality in individuals with ckd stages 3 5 a meta analysis of randomized controlled trials |
| topic | Aspirin Major adverse cardiovascular events Chronic kidney disease Mortality |
| url | https://doi.org/10.1186/s12872-024-04354-4 |
| work_keys_str_mv | AT jingwenlin effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT xueqiongcao effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT wufu effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT liuyang effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT wanxianzeng effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT nali effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT maobailiu effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials AT hongfucai effectoflowdoseaspirinonreducingcardiovasculareventsandmortalityinindividualswithckdstages35ametaanalysisofrandomizedcontrolledtrials |