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, 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 analysis (PERR) with propensity score matching, 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 myocardial infarction. Secondary outcomes were ischaemic stroke and myocardial infarction individually. Relevant confounders were included in the analysis (smoking, comorbidities, age, gender).
Findings 48 743 patients were eligible for matching. 8099 of these were aspirin users who were matched to 8099 non-users. Aspirin users had a reduced risk of the primary outcome (adjusted hazard ratio, HR 0.64; 95% confidence interval 0.52–0.79) in the PERR analysis. For both secondary outcomes, aspirin use was also associated with a reduced risk HR 0.46 (0.30–0.72) and HR 0.70 (0.55–0.91) for myocardial infarction and stroke 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.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Hamilton reports grants from National Institute for Health Research, during the conduct of the study.
Conflict of interest: Dr. Arnold has nothing to disclose.
Conflict of interest: Dr. Henley has nothing to disclose.
Conflict of interest: Dr. Payne has nothing to disclose.
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- Received April 6, 2020.
- Accepted August 24, 2020.
- Copyright ©ERS 2020