Friday, 29 March, 2024
HomeA FocusAspirin lowers risk of death in type 2 diabetes and heart failure

Aspirin lowers risk of death in type 2 diabetes and heart failure

AsprinThe first study to assess aspirin as a preventive measure for patients with both diabetes and heart failure, found a daily aspirin is associated with lower risk of death and hospitalisation for heart failure. Paradoxically, there may also be a raised the risk of non-fatal heart attack or stroke, according to the analysis eported at the American College of Cardiology’s 67th Annual Scientific Session.

Dr Charbel Abi Khalil, of Weill Cornell Medicine, Qatar, explained that the study was the first to assess aspirin as a preventive measure for patients with both diabetes and heart failure.

Aspirin is recommended strongly for patients who have suffered a myocardial infarction or stroke, but guidelines are unclear regarding its use as a preventive measure for patients with cardiovascular risk factors but no history of myocardial infarction or stroke.

Studies in patients without these types of health events have shown conflicting evidence of aspirin’s potential benefits in the general population. In patients with heart failure, some studies suggest that daily aspirin may even be harmful.

About 27m patients in the US suffer from type 2 diabetes and about 6.5m, heart failure. Each condition raises risk of cardiac events. The results shed new light on potential risks and benefits of aspirin in patients with both conditions.

According to Khalil, the paradoxical increase in non-fatal stroke and non-fatal heart attack that was parallel to the mortality decrease was surprising. These results may have been due to the patients living longer lives or they may have been predisposed to more cardiac events.

Khalil’s team used data from the UK database known as The Health Improvement Network (THIN). The THIN database is a large primary care database that contains data collected from over 550 general practitioners over the UK. The database is used to research cardiovascular disease, mental health, pharmaco-epidemiology and other fields within primary care.

THIN is a collaboration between Cegedim Strategic Data EPIC, which provides expertise in UK primary care patient data used for medical research, and In Practice Systems, who continue to develop and supply the widely used Vision general practice computer system. Cegedim is a technology and service company in digital data flow management in healthcare ecosystems.

The researchers extracted health records of more than 12,000 patients age 55 years and older who had type 2 diabetes and heart failure but no prior history of myocardial infarction, stroke, peripheral artery disease, or atrial fibrillation. Approximately half had been prescribed daily aspirin and half had not.

Researchers analysed health outcomes over an average of 5 years. All-cause mortality and hospitalisation for heart failure were tracked as a composite primary outcome. All-cause mortality, hospitalization for heart failure, major bleeding events, and nonfatal myocardial infarction or stroke were tracked separately as secondary outcomes.

An aspirin dose of >75 mg daily was assessed. The primary outcome measured was a composite of all-cause mortality with or without hospitalisation. Secondary outcome measures were non-fatal stroke, non-fatal myocardial infarction, and major bleeding.

An increase in non-fatal myocardial infarction/stroke was observed. Major bleeding was unaffected. After multivariable adjustment in a Cox regression model, aspirin was significantly associated with a decrease in the primary outcome (hazard ratio 0.89; 95% confidence interval 0.84 – 0.94). The >75 mg dose provided no benefit. Results were validated in a propensity-model score.

To summarise, those taking a daily aspirin experienced a 10% decrease in the primary outcome, no difference in major bleeding events, and a 50% increase in nonfatal myocardial infarction or stroke.

Khalil noted that diabetes and heart failure are associated with higher blood clotting activity. He also noted that because aspirin decreases platelet aggregation it may lower the odds of harmful blood clots that are responsible for myocardial infarction and stroke.

Khalil concluded that patients should speak with their doctors to assess the benefits and risks of taking aspirin. Further studies might help confirm the findings, elucidate the risks and benefits of aspirin use further in this patient population, and potentially inform specific guidelines on treatment of patients with diabetes and heart.

Abstract
Background: The impact of aspirin for primary prevention in those with type 2 diabetes (T2D) and heart failure (HF) is uncertain.
Methods: Data from The Health Improvement Network (THIN) UK primary care database were analyzed. Those with T2D and HF, age≥55y, and no previous history of myocardial infarction (MI), stroke, peripheral artery disease or atrial fibrillation were included. We compared outcomes for those on aspirin to no-aspirin after diagnosis of HF, and assessed the role of a >75mg dose. The outcomes were: Primary – a composite of all-cause mortality±HF hospitalization; Secondary: non-fatal stroke, non-fatal MI, or major bleeding.
Results: 12534 were eligible (5967 aspirin [137 >75mg] and 6567 no-aspirin). During the 5.2 (4) years of follow-up, aspirin reduced the primary outcome, and mainly, all-cause mortality (figure 1). There was an increase in non-fatal MI/stroke; major bleeding was unaffected. After multivariable adjustment in a cox-regression model, aspirin was significantly associated with a decrease in the primary outcome (HR 0.89;95%CI:0.84-0.94). There was no additional benefit for >75mg dose. Results were validated in a propensity-model score.
Conclusion: Primary prevention with aspirin in patients with T2D and HF lowers mortality, but increases non-fatal MI/stroke.

Authors
Charbel Abi Khalil, Omar Omar, Jassim Al Suwaidi and Shahrad Taheri

[link url="http://www.practiceupdate.com/content/acc-2018-aspirin-lowers-risk-of-death-in-patients-with-diabetes-and-heart-failure/64716"]ACC 2018 material[/link]
[link url="http://www.onlinejacc.org/content/71/11_Supplement/A1851?sso=1&sso_redirect_count=1&access_token="]Journal of the American College of Cardiology abstract[/link]

MedicalBrief — our free weekly e-newsletter

We'd appreciate as much information as possible, however only an email address is required.