Aspirin: Significant risk of heart failure for vulnerable patients

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The controversy over the links between aspirin and heart health has just become more complicated.

A new study reports, for the first time, that aspirin consumption “is associated with a 26% increased risk of heart failure in people with at least one predisposing factor to the disease.”

Predisposing factors included smoking, obesity, high blood pressure, high cholesterol, diabetes, and cardiovascular disease.

“This is the first study to report that among people with at least one risk factor for heart failure, those who took aspirin were more likely to later develop the disease than those who did not. not the drug, ”study author Dr Blerim Mujaj of the University of Freiburg, Germany, said in a prepared statement.

Although the results require confirmation, “they indicate that the potential link between aspirin and heart failure needs to be clarified.”

Controversy

If you have ever had a heart attack or stroke, or have slowed blood flow, the benefit of taking aspirin daily, to prevent clotting, is well established, unless you have severe allergy or history of bleeding.

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This is called secondary prevention.

Primary prevention is another matter.

This is the practice that healthy older people – who have never had a heart attack, stroke, coronary artery bypass surgery, or blocked arteries – take low-dose aspirin daily. to avoid a cardiovascular event.

Tens of millions of people around the world have adopted this habit.

It has been the subject of debate for years, with concern that the risk of bleeding outweighs the benefits of protection.

Last year, data from the Aspirin in Reducing Events in the Elderly (ASPREE) trial found that prolonged daily use of aspirin increases the risk of gastrointestinal bleeding by at least 60% in the elderly. 70 years and over.

As reported by the Royal College of General Practitioners, this research – in tandem with other trials – “spelled the end of the use of aspirin for primary prevention.”

The German study aimed to assess the relationship of aspirin with the incidence of heart failure in people with and without heart disease, and to determine whether the use of the drug is linked to a new diagnosis of heart failure. in people at risk.

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The study

According to an explanation from the European Society of Cardiology, the analysis included 30,827 people at risk of developing heart failure who were enrolled in Western Europe and the United States in the HOMAGE study, an ongoing project on the heart failure and aging.

“At risk” has been defined as one or more of the following: smoking, obesity, high blood pressure, high cholesterol, diabetes and cardiovascular disease.

Participants were aged 40 and over and had no heart failure at baseline.

Aspirin use was recorded during registration and participants were categorized into users or non-users.

Participants were followed for the first incidence of fatal or non-fatal heart failure requiring hospitalization.

The average age of the participants was 67 and 34% were female. Initially, a total of 7698 participants (25%) were taking aspirin.

During the 5.3-year follow-up, 1330 participants developed heart failure.

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What the data revealed

Investigators assessed the association between aspirin use and incident heart failure after adjusting for gender, age, body mass index, smoking, alcohol consumption, blood pressure, heart rate, blood cholesterol and a number of diseases and drugs related to the heart.

Aspirin intake was independently associated with a 26% increased risk of being re-diagnosed with heart failure.

To check the consistency of the results, the researchers repeated the analysis after matching aspirin users and non-users for heart failure risk factors.

Dr Mujaj said: “Aspirin is commonly used – in our study one in four participants was taking the drug. In this population, aspirin use was associated with incident heart failure, independent of other risk factors.

A caveat: “Large, multinational randomized trials in adults at risk for heart failure are needed to verify these results. So far, our observations suggest that aspirin should be prescribed with caution in people with heart failure or with risk factors for the disease. “

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