Study Suggests Aspirin Use Is Associated With Increased Risk of Heart Failure in Patients With Predisposing Factors

November 23, 2021—The European Society of Cardiology (ESC) announced the publication of a study demonstrating that aspirin use is associated with a 26% raised risk of heart failure in people with at least one predisposing factor for the condition. Predisposing factors included smoking, obesity, high blood pressure, high cholesterol, diabetes, and cardiovascular disease.

An early view of the findings was published online by Blerim Mujaj, MD, et al in the society’s journal, ESC Heart Failure.

Dr. Mujaj, who is with the University of Freiburg in Germany, commented in the ESC press release, “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. While the findings require confirmation, they do indicate that the potential link between aspirin and heart failure needs to be clarified.”

As noted in the ESC press release, 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.

According to ESC, the analysis included 30,827 individuals at risk for developing heart failure who were enrolled from Western Europe and the United States into the HOMAGE study.

In the analysis, “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 years and free of heart failure at baseline. Aspirin use was recorded at enrollment and participants were classified as users or nonusers. Participants were followed-up for the first incidence of fatal or nonfatal heart failure requiring hospitalization.

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, and cardiovascular disease and treatment with renin-angiotensin-aldosterone-system inhibitors, calcium channel blockers, diuretics, beta-blockers, and lipid-lowering drugs.

The investigators found that taking aspirin was independently associated with a 26% raised risk of a new heart failure diagnosis.

ESC noted that to check the consistency of the results, the investigators repeated the analysis after matching aspirin users and nonusers 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.

In the ESC press release, Dr. Mujaj stated, “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 participants were taking the medication. In this population, aspirin use was associated with incident heart failure, independent of other risk factors.”

Dr. Mujaj concluded, “Large multinational randomized 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.”