EFFECT OF ASPIRIN USE ON DEATH AND RECURRENT MYOCARDIAL-INFARCTION INCURRENT AND FORMER CIGARETTE SMOKERS

The purpose of this study was to examine the effects of aspirin use on mortality and morbidity rates in a subset of the control group of the Program on the Surgical Control of the Hyperlipidemias (POSCH) that w as stratified by cigarette smoking status at the time of randomization . The clinical impact of aspirin intake in cigarette smokers and forme r cigarette smokers has not been well studied. POSCH was a randomized, controlled, clinical trial designed to ascertain the effects of lipid modification by the partial ileal bypass operation on clinical end-po ints and arteriographic changes in postmyocardial infarction subjects with hypercholesterolemia. Cohorts of cigarette smokers in the diet-co ntrol group were evaluated for overall and atherosclerotic coronary he art disease (ACHD) mortality rates and recurrent confirmed nonfatal my ocardial infarction rates. In current cigarette smokers at baseline (n = 90) with a mean follow-up of 8.3 years, the overall mortality rate was 45.2% in patients with no aspirin use and 10.4% in patients who re ported even infrequent aspirin use (relative risk = 4.3, 95% confidenc e interval (CI) = 2.4 to 10.6, p < 0.001). For ACHD mortality in this cohort, the relative risk was 17.1 (35.7% vs 2.1%, 95% CI = 1.4 to 125 .0, p < 0.001); for the combined end-point of ACHD mortality and nonfa tal myocardial infarction, the relative risk was 2.4 (40.5% vs 16.7%, 95% CI = 1.2 to 5.1, p = 0.018). In former cigarette smokers with no a spirin use at baseline (n = 92) with a mean follow-up of 8.8 years, th e relative risk of overall mortality was 3.1 (20.0% vs 6.5%, 95% CI = 1.0 to 10.2, p = 0.07), ACHD mortality, 3.4 (16.7% vs 4.8%, 95% CI = 0 .9 to 13.5, p = 0.11); and combined ACHD mortality and confirmed nonfa tal myocardial infarction, 1.1 (23.3% vs 21.0%, 95% CI = 0.5 to 2.5, p = 0.79). After adjustment for age, gender, low-density lipoprotein ch olesterol, high-density lipoprotein cholesterol, Quetelet index, eject ion fraction, extent of coronary disease at baseline, and length of fo llow-up, none of these relative risks changed appreciably. The risk of overall mortality, ACHD mortality, and combined ACHD mortality and re current confirmed nonfatal myocardial infarction may be significantly reduced by aspirin use in post-myocardial infarction cigarette smokers . However,the subjects included in this analysis were highly selected and may not be totally representative of postmyocardial infarction pat ients. Nonetheless, when extensive counseling regarding the negative c onsequences of continued cigarette smoking fails to cause smoking cess ation in postmyocardial infarction patients, it may be exceedingly pru dent to recommend aspirin usage.