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Aspirin link to 26% higher heart failure risk in some — HOMAGE study

Aspirin use is associated with a 26% raised risk of heart failure in people with at least one predisposing factor for the condition. That's the finding of a study published in ESC Heart Failure, a journal of the European Society of Cardiology (ESC). Predisposing factors included smoking, obesity, high blood pressure, high cholesterol, diabetes, and cardiovascular disease.

“This is the first study to report that among individuals with a least one risk factor for heart failure, those taking aspirin were more likely to subsequently develop the condition than those not using the medication,” said study author Dr Blerim Mujaj of the University of Freiburg, Germany.

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

The influence of aspirin on heart failure is controversial. This study aimed to evaluate its relationship with heart failure incidence in people with and without heart disease and assess whether using the drug is related to a new heart failure diagnosis in those at risk.

The analysis included 30,827 individuals at risk for developing heart failure who were enrolled from Western Europe and the US into the HOMAGE study. “At risk” was defined as one or more of the following: smoking, obesity, high blood pressure, high cholesterol, diabetes and cardiovascular disease. Participants were aged 40 and older, and free of heart failure at baseline. Aspirin use was recorded at enrolment and participants were classified as users or non-users. Participants were followed-up for the first incidence of fatal or non-fatal heart failure requiring hospitalisation.

The average age of participants was 67 years and 34% were women. At baseline, a total of 7,698 participants (25%) were taking aspirin. During the 5.3-year follow-up, 1,330 participants developed heart failure.

The investigators assessed the association between aspirin use and incident heart failure after adjusting for sex, age, body mass index, smoking, alcohol use, blood pressure, heart rate, blood cholesterol, creatinine, hypertension, diabetes, cardiovascular disease, and treatment with renin-angiotensin-aldosterone-system inhibitors, calcium channel blockers, diuretics, beta-blockers and lipid-lowering drugs. Taking aspirin was independently associated with a 26% raised risk of a new heart failure diagnosis.

To check the consistency of the results, the researchers repeated the analysis after matching aspirin users and non-users for heart failure risk factors. In this matched analysis, aspirin was associated with a 26% raised risk of a new heart failure diagnosis. To check the results further, the analysis was repeated after excluding patients with a history of cardiovascular disease. In 22,690 participants (74%) free of cardiovascular disease, aspirin use was associated with a 27% increased risk of incident heart failure.

Mujaj said: “This was the first large study to investigate the relationship between aspirin use and incident heart failure in individuals with and without heart disease and at least one risk factor. Aspirin is commonly used: in our study one in four were taking the medication. In this population, aspirin use was associated with incident heart failure, independent of other risk factors.”

Large multinational randomised trials in adults at risk for heart failure were needed to verify these results, he added. “Until then, our observations suggest that aspirin should be prescribed with caution in those with heart failure or with risk factors for the condition.”

Study details
Aspirin use is associated with increased risk for incident heart failure: a patient‐level pooled analysis

Blerim Mujaj, Zhen‐Yu Zhang, Wen‐Yi Yang, Lutgarde Thijs, Fang‐Fei Wei, Peter Verhamme, Christian Delles, Javed Butler, Peter Sever, Roberto Latini, John GF Cleland, Faiez Zannad, Jan A. Staessen.

Published in ESC Heart Failure on 22 November 2021

Abstract

Aims
Recent trials evaluating the effect of aspirin in the primary prevention of cardiovascular disease showed little or no benefit. However, the role of aspirin on the risk of incident heart failure (HF) remains elusive. This study aimed to evaluate the role of aspirin use on HF incidence in primary and secondary prevention and whether aspirin use increases the risk of incident HF in patients at risk.

Methods and results
Data from 30 827 patients at risk for HF enrolled in six observational studies were analysed [women 33.9%, mean age (±standard deviation) 66.8 ± 9.2 years]. Cardiovascular risk factors and aspirin use were recorded at baseline, and patients were followed up for the first incident of fatal or non-fatal HF. The association of incident HF with aspirin use was assessed using multivariable-adjusted proportional hazard regression, which accounted for study and cardiovascular risk factors. Over 5.3 years (median; 5th–95th percentile interval, 2.1–11.7 years), 1330 patients experienced HF. The fully adjusted hazard ratio (HR) associated with aspirin use was 1.26 [95% confidence interval (CI) 1.12–1.41; P ≤ 0.001]. Further, in a propensity-score-matched analysis, the HR was 1.26 (95% CI 1.10–1.44; P ≤ 0.001). In 22 690 patients (73.6%) without history of cardiovascular disease, the HR was 1.27 (95% CI 1.10–1.46; P = 0.001).

Conclusions
In patients, at risk, aspirin use was associated with incident HF, independent of other risk factors. In the absence of conclusive trial evidence, our observations suggest that aspirins should be prescribed with caution in patients at risk of HF or having HF.

 

ESC Heart Failure article – Aspirin use is associated with increased risk for incident heart failure: a patient-level pooled analysis (Open access)

 

See more from MedicalBrief archives:

 

Canadian review: Aspirin not recommended for those not at risk of CVD

 

Low-dose aspirin of no benefit for CVD-free people over 70

 

Aspirin not increasing heart failure events in heart failure patients – WARCEF trial

 

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