Aspirin May be Safe for Heart Failure Patients

Large clinical trial shows no increase in adverse events from treatment with aspirin for heart failure.

Cardiologists have expressed concerns that aspirin could increase the risk of hospitalization and mortality among patients with heart failure who are taking first-line therapies.

However, findings from a new study published by JACC: Heart Failure suggest that aspirin may be safe for patients taking angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs).

"These findings allay concerns regarding the safety of aspirin for heart failure patients," said senior author Shunichi Homma, MD.

The Warfarin and Aspirin for Reduced Cardiac Ejection Fraction is the largest clinical trial comparing the use of aspirin and warfarin for heart failure, according to the authors. The 10-year study followed 2305 patients who have heart failure with reduced ejection fraction. Patients included had normal sinus rhythm and were all on drug therapy.

Previous smaller studies suggest that aspirin may cause a biochemical interaction with ACE inhibitors and ARBs, and could lead to adverse events.

In the new sub-study, the authors concluded that taking aspirin does not increase the risk of heart failure events in these patients, as there was no difference in adverse events among patients taking aspirin or warfarin.

These findings are meaningful because numerous patients with and without heart failure take aspirin as a way to relieve pain or to prevent cardiovascular events.

"Up to 40% of Americans take aspirin, and in heart failure patients, this number may be even higher," said study co-author Susan Graham, MD. "It's a great relief to learn that aspirin is safe for this population. One challenge in cardiology is that we may need to use many drugs, including 2 or 3 blood thinners. We always want to be sure we're helping patients, not creating problems.

The authors found neither aspirin nor warfarin provided superior protection against preventing the risk of death, stroke, and cerebral hemorrhage in patients with heart failure and a normal heart rhythm, according to the study.

Additionally, warfarin is known to be difficult to manage due to a heightened risk of severe bleeding events. If aspirin is as effective, patients may be able to substitute warfarin.

"Knowledge that aspirin is safe could have implications extending beyond the world of heart failure since ACE inhibitors are also used as a front-line therapy for hypertension and diabetes," Dr Graham concluded.