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

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.

Keywords: Aspirin use; Cardiovascular diseases; Heart failure; Primary prevention; Secondary prevention.

FIGURE 1

Panels (A), (B), (C), and (D) show study, sex‐standardized, and age‐standardized cumulative incidence of heart failure in participants using aspirin use (red line) and non‐using aspirin (blue line). The tabulated numbers represent the participants at risk with intervals in years. P‐value is for the significance of the difference between aspirin use and non‐use.

FIGURE 2

Panels (A) and (B) represent the plotted hazard ratio of systolic and diastolic blood pressure categories in stratified analyses fully adjusted for all risk factors presented in Table 1 . Panel (C) represents the risk of heart failure based on the concomitant use of antihypertensive drugs by class and statin medication for participants treated and not treated with aspirin and plotted as a hazard ratio and 95% confidence interval. P‐value is for the significance of the difference between aspirin use and non‐use. P‐interaction represents the P‐value for the interaction.