Cardiometabolic Risk Raises GI Bleeding in Aspirin Users - EMJ

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Higher Cardiometabolic Risk Increases Gastrointestinal Bleeding in Aspirin Users

Higher Cardiometabolic Risk Increases Gastrointestinal Bleeding in Aspirin Users

A NEW study has revealed that aspirin users with multiple cardiometabolic risk factors, including diabetes, hypertension, and obesity, face a significantly greater risk of gastrointestinal (GI) bleeding. The findings, drawn from a large UK cohort, underscore the need for more personalised approaches when prescribing long-term aspirin therapy for cardiovascular disease prevention. Researchers say that while aspirin remains a cornerstone of secondary prevention, its risks must be carefully balanced against its well-known cardiovascular benefits.

Risk Rises with Cardiometabolic Burden

The analysis included data from 12,781 adults enrolled in the UK Biobank who had a history of ischaemic cardiovascular disease and an active aspirin prescription. Participants were assessed for four key cardiometabolic risk factors—obesity, diabetes, dyslipidaemia, and hypertension—and followed for an average of 13.4 years to monitor their first GI bleeding event.

Rates of GI bleeding increased progressively with each additional risk factor, rising from 4.53 cases per 1,000 person-years among those with none to 9.64 per 1,000 person-years among those with all four. After adjusting for potential confounders, the hazard ratios (HRs) increased steadily from 1.09 for one risk factor to 1.95 for four (P-trend < 0.001), indicating a clear dose–response relationship.

Among individual risk factors, diabetes (HR = 1.24; 95% CI: 1.02–1.51) and hypertension (HR = 1.24; 95% CI: 1.08–1.42) were most strongly linked to bleeding events. The effect was especially pronounced among men, younger adults, and individuals with a history of gastrointestinal disorders, suggesting that these groups may require closer clinical monitoring.

Implications for Clinical Practice

Lead author Dr Yajing Wei and colleagues emphasised that clinicians should consider a patient’s overall cardiometabolic burden when evaluating the bleeding risk associated with aspirin therapy.

“These findings highlight the importance of tailored risk assessment to ensure that the cardiovascular benefits of aspirin outweigh potential gastrointestinal harms,” the authors wrote.

The study reinforces the importance of risk stratification, preventive care, and regular monitoring in patients with cardiovascular disease who depend on chronic aspirin therapy, particularly those with multiple metabolic comorbidities.

Reference

Wei Y et al. Association of cardiometabolic risk burden with gastrointestinal bleeding in aspirin users. BMC Gastroenterol. 2025; DOI: 10.1186/s12876-025-04347-3.

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