The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of COVID-19 infection
Merzon et al.
, The use of aspirin for primary prevention of cardiovascular disease is associated with a lower likelihood of..
, The FEBS Journal, doi:10.1111/febs.15784
Retrospective 10,477 patients in Israel, showing lower risk of COVID-19 cases with existing aspiring use.
risk of case, 27.6% lower, RR 0.72, p = 0.04, treatment 73 of 1,621 (4.5%), control 589 of 8,856 (6.7%), NNT 47, adjusted per study, odds ratio converted to relative risk.
risk of death, 62.4% lower, RR 0.38, p = 0.51, treatment 1 of 21 (4.8%), control 6 of 91 (6.6%), adjusted per study, odds ratio converted to relative risk.
time to viral-, 9.6% lower, relative time 0.90, p = 0.045, treatment 73, control 589, time to 2nd negative test.
time to viral-, 14.8% lower, relative time 0.85, p = 0.005, treatment 73, control 589, time to 1st negative test.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Merzon et al., 23 Feb 2021, retrospective, Israel, peer-reviewed, 8 authors.
Abstract: The use of aspirin for primary prevention of cardiovascular
disease is associated with a lower likelihood of COVID-19
Eugene Merzon1,2, Ilan Green1,2, Shlomo Vinker1,2, Avivit Golan-Cohen1,2, Alessandro Gorohovski4,
Eva Avramovich1,3, Milana Frenkel-Morgenstern4
and Eli Magen1,5
1 Leumit Health Services, Tel-Aviv, Israel
2 Department of Family Medicine, Sackler Faculty of Medicine, Tel-Aviv University, Israel
3 Department of Management, Bar-Ilan University, Safed, Israel
4 Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
5 Medicine C Department, Clinical Immunology and Allergy Division, Barzilai University Medical Center, Ben-Gurion University of the
Negev, Ashkelon, Israel
aspirin; COVID-19; disease likelihood; Israeli
M. Frenkel-Morgenstern, Azrieli Faculty of
Medicine, Bar-Ilan University, Safed, Israel
Eugene Merzon and Ilan Green contributed
equally to this article
(Received 12 November 2020, revised 18
January 2021, accepted 22 February 2021)
Acetylsalicylic acid (aspirin) is commonly used for primary and secondary
prevention of cardiovascular diseases. Aspirin use is associated with better
outcomes among COVID-19 positive patients. We hypothesized that the
aspirin use for primary cardiovascular disease prevention might have a protective effect on COVID-19 susceptibility and disease duration. We conducted a retrospective population-based cross-sectional study, utilizing data
from the Leumit Health Services database. The proportion of patients treated with aspirin was significantly lower among the COVID-19-positive
group, as compared to the COVID-19-negative group [73 (11.03%) vs.
1548 (15.77%); P = 0.001]. Aspirin use was associated with lower likelihood of COVID-19 infection, as compared to nonusers (adjusted OR 0.71
(95% CI, 0.52 to 0.99; P = 0.041). Aspirin users were older (68.06 12.79
vs. 56.63 12.28 years of age; P < 0.001), presented a lower BMI
(28.77 5.4 vs. 30.37 4.55; P < 0.0189), and showed higher prevalence
of hypertension (56, 76.71%), diabetes (47, 64.38%), and COPD (11,
15.07%) than the aspirin nonusers (151, 25.64%, P < 0.001; 130, 22.07%,
P < 0.001; and 43, 7.3%, P = 0.023, respectively). Moreover, COVID-19
disease duration (considered as the time between the first positive and second negative COVID-19 RT–PCR test results) among aspirin users was
significantly shorter, as compared to aspirin nonusers (19.8 7.8 vs.
21.9 7.9 P = 0.045). Among hospitalized COVID-positive patients, a
higher proportion of surviving subjects were treated with aspirin (20,
19.05%), as opposed to 1 dead subject (14.29%), although this difference
was not significant (P = 0.449). In conclusion, we observed an inverse association between the likelihood of COVID-19 infection, disease duration
and mortality, and aspirin use for primary prevention.
COVID-19, coronavirus SARS-CoV-2; CVD, cardiovascular disease; LHS, Leumit Health Services; SES, socioeconomic status; STING,
stimulator of interferon genes.
The FEBS Journal 288 (2021) 5179–5189 ª 2021 Federation of European Biochemical Societies
E. Merzon et al.
The use of aspirin lowers COVID-19 susceptibility
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