Abstract
Background Ischaemic stroke and myocardial infarction (MI) are common after pneumonia and are associated with long-term mortality. Aspirin may attenuate this risk and should be explored as a therapeutic option.
Methods We extracted all patients with pneumonia (aged over 50 years) from the Clinical Practice Research Datalink (CPRD), a large UK primary care database, from inception until January 2019. We then performed a prior event rate ratio (PERR) analysis with propensity score matching (PSM), an approach that allows for control of measured and unmeasured confounding, with aspirin usage as the exposure and ischaemic events as the outcome. The primary outcome was the combined outcome of ischaemic stroke and MI. Secondary outcomes were ischaemic stroke and MI individually. Relevant confounders (smoking, comorbidities, age and gender) were included in the analysis.
Findings 48 743 patients were eligible for matching. Of these, 9864 were aspirin users who were matched to 9864 non-users. Aspirin users had a reduced risk of the primary outcome (adjusted hazard ratio 0.64, 95% CI 0.52–0.79) in the PERR analysis. For both secondary outcomes, aspirin use was also associated with a reduced risk for MI (hazard ratio 0.46, 95% CI 0.30–0.72) and stroke (hazard ratio 0.70, 95% CI 0.55–0.91), respectively.
Interpretation This study provides supporting evidence that aspirin use is associated with reduced ischaemic events after pneumonia in a primary care setting. This drug may have a future clinical role in preventing this important complication.
Abstract
Aspirin use was associated with reduced cardiovascular events after a pneumonia episode in a large UK primary care cohort and is a promising avenue in managing cardiovascular risk in pneumonia https://bit.ly/2YBkPXJ
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.03778-2020
This article has supplementary material available from erj.ersjournals.com
Unfortunately, the Clinical Practice Research Datalink (CPRD) does not allow direct data sharing due to patient confidentiality issues. The lead author would welcome informal and formal contact if required. It is not feasible to disseminate results back to individual patients within the CPRD. Ethical approval for this study was given by the CPRD, who safeguard patient information in this database (www.cprd.com/safeguarding-patient-data), application ISAC 18_310R.
Author contributions: F. Hamilton and D. Arnold conceived of the idea. F. Hamilton designed the study, did the majority of the analysis and wrote the first draft. D. Arnold helped with the analysis, editing and methodology. W. Henley did some analysis, and provided methodological support and editing. R.A. Payne was the senior supervisor, conceptualised the work and performed editing. The lead author affirms that this manuscript is an honest, accurate and transparent account of the study being reported, that no important aspects of the study have been omitted and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Conflict of interest: F. Hamilton reports grants from the National Institute for Health Research (NIHR) (the Academic Clinical Fellowship Scheme), during the conduct of the study.
Conflict of interest: D. Arnold has nothing to disclose.
Conflict of interest: W. Henley has nothing to disclose.
Conflict of interest: R.A. Payne has nothing to disclose.
Support statement: F. Hamilton was funded by the National Institute for Health Research (NIHR), through the Academic Clinical Fellowship Scheme. D. Arnold was funded by the NIHR, through a Doctoral Training Fellowship (DRF-2018-11-ST2-065). W. Henley was funded by the NIHR Applied Research Collaboration South West Peninsula. The study was supported by the NIHR Health Protection Research Unit in Evaluation of Interventions. The views expressed are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR, the Department of Health or Public Health England. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received April 6, 2020.
- Accepted August 24, 2020.
- Copyright ©ERS 2021
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