Aspirin linked with increased risk of heart failure

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

The influence of aspirin on heart failure is controversial, so the new 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, aged 40 years and above, who were enrolled from Western Europe and the US into the HOMAGE study. At baseline, a total of 7698 participants (25%) were taking aspirin. During the 5.3-year follow-up, 1330 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.

“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, from the University of Freiburg.

“Aspirin is commonly used — in our study one in four participants were taking the medication,” he continued. “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 are needed to verify these results. Until then, our observations suggest that aspirin should be prescribed with caution in those with heart failure or with risk factors for the condition.”

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