Preventive Cardiology

Aspirin’s Lp(a) Primary Prevention Potential

An observational study out of Emory suggests that aspirin could be the preventative Lp(a) treatment we’ve been looking for, finding that people with high Lp(a) levels who regularly take aspirin might significantly reduce their ASCVD mortality risks. 

The researchers analyzed 26-year outcomes from 2,990 people without clinical ASCVD (representative of 73M US adults), including 7% who regularly took aspirin, finding that…

  • Among participants with high Lp(a) levels, daily aspirin-takers had far lower ASCVD mortality rates per 1,000 person-years than those who didn’t regularly take aspirin (1.2 vs. 3.9).
  • Multivariable modeling revealed that regular aspirin was associated with a 52% lower risk of ASCVD mortality among high Lp(a) participants, but not in aspirin-takers who didn’t have high Lp(a).

The fact that aspirin-takers who had high Lp(a) levels had 52% lower mortality risks compared to the aspirin-takers with normal Lp(a) levels got people talking on CardioTwitter, leading to a number of theories (e.g. aspirin’s inflammation benefits), and criticisms (e.g. the study’s reliance on observational and survey data), while most online commenters called for an RCT to know for sure.

Until we get an RCT, any supporters or doubters of this research might be interested to see a pair of previous studies that found high-Lp(a) individuals who regularly took aspirin had a 46% lower risk of coronary heart disease events and 45-55% lower MACE risks.

The Takeaway

Around 20% of people have high Lp(a) levels, but there’s currently no FDA-approved Lp(a) treatment, which creates little reason for Lp(a) testing. A lot more research is needed, but if aspirin truly does prove to slash ASCVD mortality, it could address Lp(a)’s treatment and testing problems, and have a major public health impact in the process.

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