Low-dose aspirin cuts heart attack risk 38% and kidney failure risk 28% in CKD patients with Lp(a) of 50 mg/dL or above, but not below it, CRIC cohort finds (JACC Adv 2025)

Original title: Primary Prevention Aspirin, Lipoprotein(a), and Cardiorenal Outcomes in Chronic Kidney Disease: Chronic Renal Insufficiency Cohort

JACC Adv · 19 August 2025 · 7

Razavi AC, Chen J, Yang W, Sha D, Dzaye O, Bhatia HS, Tsimikas S, Lash JP, Kansal M, Rincon-Choles H, Vaccarino V, Jacobson TA et al.

This analysis of the Chronic Renal Insufficiency Cohort (CRIC) followed 2,552 participants with chronic kidney disease but no clinical cardiovascular disease (mean age 55.8 years, 48% women, 27% with Lp(a) at or above 50 mg/dL) over a median 15.7 years, testing whether primary-prevention aspirin's benefit varies by Lp(a) level. Among those with Lp(a) of 50 mg/dL or above, aspirin use was associated with 38% lower risk of myocardial infarction (HR 0.62, 95% CI 0.42-0.91) and 28% lower risk of end-stage renal disease (HR 0.72, 95% CI 0.59-0.89); no such benefit, and even a signal of higher MI risk, was seen in those with Lp(a) below 50 mg/dL (MI HR 1.38; ESRD HR 0.98). Aspirin was not significantly linked to stroke or major bleeding in either group. The authors conclude CKD patients with elevated Lp(a) and no clinical cardiovascular disease may derive net benefit from low-dose aspirin for both cardiovascular and renal protection.

Original abstract

Background: Chronic kidney disease (CKD) is a risk-enhancing factor for cardiovascular disease (CVD) and is associated with higher lipoprotein(a) (Lp[a]) levels. While aspirin may reduce Lp(a)-related prothrombotic risk, the role of primary prevention aspirin for persons with CKD and elevated Lp(a) is unclear.

Objectives: The aim of the study was to assess the association of aspirin use with cardiovascular, renal, and bleeding outcomes stratified by Lp(a) level among individuals with CKD without clinical CVD.

Methods: There were 2,552 participants without clinical CVD in the Chronic Renal Insufficiency Cohort. Lp(a) was measured at baseline and not reported to clinicians. Aspirin use was self-reported and longitudinally assessed at each follow-up visit. Cox proportional hazards regression assessed the association of aspirin use with myocardial infarction (MI), stroke, end-stage renal disease (ESRD), and major bleeding events, stratified by Lp(a) ≥50 vs <50 mg/dL.

Results: Mean age was 55.8 years, 48% were women, 34% reported aspirin use at baseline, 27% had Lp(a) ≥50 mg/dL, and mean estimated glomerular filtration rate was 47 mL/min/1.73 m2. Over a median follow-up of 15.7 years, aspirin use was associated with a 38% lower risk of MI (HR: 0.62; 95% CI: 0.42-0.91) and a 28% lower risk of ESRD (HR: 0.72; 95% CI: 0.59-0.89) among individuals with Lp(a) ≥50 but not Lp(a) <50 mg/dL (MI, HR: 1.38; 95% CI: 1.07-1.77; ESRD, HR: 0.98; 95% CI: 0.84-1.15). Aspirin use was not significantly associated with stroke or major bleeding in either Lp(a) group.

Conclusions: Individuals with CKD and elevated Lp(a) without clinical CVD may derive net benefit from low-dose aspirin for the primary prevention of MI and ESRD.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.