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

Mujaj, B. et al. (2022) Aspirin use is associated with increased risk for incident heart failure: a patient-level pooled analysis. ESC Heart Failure, 9(1), pp. 685-694. (doi: 10.1002/ehf2.13688) (PMID:34808706) (PMCID:PMC8787993)

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.

• Item Type: Articles
• Additional Information: Funding: The European Union (HEALTH-F7-305507 HOMAGE), the European Research Council (Advanced Researcher Grant 2011-294713-EPLORE), the European Research Council (Proof-of-Concept Grant 713601-uPROPHET), and the European Research Area Net for Cardiovascular Diseases (JTC2017-046-PROACT) supported the Research Unit Hypertension and Cardiovascular Research.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John and Delles, Professor Christian
• Authors: Mujaj, B., ZHang, Z.-Y., Yang, W.-Y., Thijs, L., Wei, F.-F., Verhamme, P., Delles, C., Butler, J., Sever, P., Latini, R., Cleland, J. G. F., Zannad, F., and Staessen, J. A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health; College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: ESC Heart Failure
• Publisher: Wiley
• ISSN: 2055-5822
• ISSN (Online): 2055-5822
• Published Online: 22 November 2021
• Copyright Holders: Copyright © 2021 The Authors
• First Published: First published in ESC Heart Failure 9(1): 685-694
• Publisher Policy: Reproduced under a Creative Commons licence