Low-Dose Aspirin Falls Short in Preventing First Cardiovascular Events in Kidney Disease
A trial in older adults with kidney disease found no clear overall cardiovascular benefit from daily aspirin, despite fewer nonfatal strokes.
Summary
Low-dose aspirin did not clearly prevent first cardiovascular events in adults with chronic kidney disease in the randomized ATTACK trial. Researchers assigned 4,633 adults, averaging 73 years old, to daily aspirin or no aspirin alongside usual care. After about three years, heart attacks, strokes, or cardiovascular deaths occurred in 2.4% of the aspirin group versus 3.3% of the comparison group, a difference that was not statistically significant. Nonfatal strokes were significantly less frequent with aspirin, but overall deaths and major bleeding did not differ significantly. Recruitment fell far short of the planned 25,000 participants, leaving uncertainty about potential benefits and harms. The findings do not support routinely starting aspirin to prevent a first cardiovascular event in this population. They do not change its established role after cardiovascular events.
Detailed Summary
Low-dose aspirin has an uncertain role in preventing a first heart attack or stroke in adults with chronic kidney disease. Kidney disease raises cardiovascular risk, but it can also increase bleeding risk, making aspirin's benefits and harms especially important to weigh. The ATTACK trial tested whether daily aspirin improved outcomes in this population without established cardiovascular disease.
Researchers randomized 4,633 adults to 75 mg of aspirin daily or no aspirin alongside usual care. Participants averaged 73 years old. Over 3.1 years, major vascular events occurred in 2.4% taking aspirin versus 3.3% without aspirin. This difference did not reach statistical significance, so the study did not establish an overall preventive benefit.
Aspirin was associated with a statistically significant reduction in nonfatal stroke, with a hazard ratio of 0.51. However, this was one component of the main outcome, not proof that aspirin improves overall cardiovascular health in this setting. Death from any cause, major bleeding, and other bleeding outcomes did not differ significantly between groups.
For adults with kidney disease who have never had cardiovascular disease, these results do not support routinely starting aspirin for prevention. Discuss personal cardiovascular and bleeding risks with a clinician rather than treating aspirin as a longevity supplement. The findings do not overturn aspirin's established role in secondary prevention after cardiovascular events; do not stop prescribed treatment without medical advice.
The trial recruited far fewer participants than its planned 25,000 because of pandemic disruptions, limiting its ability to detect meaningful differences. Its open-label design and predominantly white population also warrant caution. Participants with elevated bleeding risk were excluded, so the absence of a significant bleeding difference does not establish safety for everyone. These conference findings, reported in an incomplete news article, need confirmation against the full trial report before drawing firm conclusions about which patients might ultimately benefit most.
Key Findings
- Daily aspirin did not significantly reduce first major cardiovascular events: 2.4% versus 3.3% over an average of 3.1 years.
- Nonfatal stroke was significantly less frequent with aspirin, but this component finding does not establish an overall cardiovascular benefit.
- Major bleeding did not differ significantly; excluding adults at elevated bleeding risk limits reassurance about safety.
- Enrollment reached 4,633 participants rather than the planned 25,000, limiting the trial's ability to resolve benefits and harms.
- Do not routinely start aspirin for primary prevention based on these findings or stop prescribed aspirin without clinician guidance.
Methodology
This MedPage Today news report covers randomized trial findings presented at the American Society of Nephrology Kidney Week meeting. The pragmatic, multicenter, open-label ATTACK trial compared daily aspirin with no aspirin alongside usual care and tracked outcomes through routinely collected hospital data. Randomization strengthens the evidence, but conference reporting is not a substitute for reviewing the full study.
Study Limitations
Recruitment was substantially below target, and a nonsignificant primary result does not prove aspirin has no benefit. The predominantly white, older population and exclusion of adults at elevated bleeding risk limit generalizability. The supplied article is truncated; verify the full trial report, endpoint definitions, bleeding estimates, and handling of multiple comparisons before interpreting the stroke finding as definitive.
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