Doubts about common medicine: aspirin is actually supposed to prevent thrombosis and cardiovascular diseases. But the drug can even increase the risk of chronic heart failure, as a meta-study now suggests. According to this, the risk of heart problems increases by 26 percent with prolonged intake of aspirin – and that of all patients who are particularly at risk due to high cholesterol levels, diabetes, obesity and other risk factors.
Aspirin is one of the most commonly used drugs in the world. Acetylsalicylic acid (ASA) has an analgesic, fever-lowering, blood-thinning effect, helps with high cholesterol levels and is even said to be able to prevent some types of cancer. Many people therefore take aspirin regularly over a long period of time – especially as a prevention against thrombosis and cardiovascular diseases.
But the positive effects of aspirin against cardiovascular diseases are controversial. While some studies show a preventive effect and reduced mortality, others could not find any positive correlation with ASA intake. There was even initial evidence that aspirin actually increased the risk of heart failure in some patients. Doctors understand heart failure or heart failure as a decrease in the performance of the heart – be it due to narrowing of the coronary arteries, fat deposits or other factors.
Keeping an eye on the risk of heart failure
To investigate this suspicion, Blerim Mujaj from the Catholic University of Leuven and his colleagues evaluated study data from 30,827 participants from twelve countries. All men and women aged 40 and over had at least one risk factor, including being overweight, smoking, high blood pressure, high cholesterol, diabetes, or atherosclerosis. Around a quarter of the participants had also experienced a heart attack, stroke or cardiac arrhythmia in the past. At the beginning of her studies, however, her heart was considered healthy.
“This is the first study to examine the link between aspirin use and heart failure in people with and without a history of cardiovascular disease and with at least one risk factor,” says Mujaj. Around a quarter of the test subjects took aspirin regularly during the study period.
Risk increased by 26 percent
The evaluations showed: A total of 1,330 participants suffered heart disease over the course of the five-year follow-up, which resulted in heart failure and thus heart failure. Among these, patients who regularly took aspirin were disproportionately represented. Overall, the risk for them was 26 percent higher, as Mujaj and his team found.
This increased risk of heart failure persisted even when the researchers specifically only compared patients of the same age and comparable risk factors. “Regardless of which data sets we used and how much we considered possible influencing factors, the risk of heart failure was always positively linked to aspirin intake,” the scientists write.
It stayed that way when they excluded all patients with a history of cardiovascular disease. Then the risk was even 27 percent higher than for the participants who did not take aspirin.
Prescribe aspirin with caution
“This is the first study that shows a clearly increased risk of heart failure in people with at least one risk factor when taking aspirin,” state Mujaj and his colleagues. In their opinion, the results demonstrate that the benefits of preventive use of ASA should at least be re-examined more closely in view of the possible risks. “We now need large, randomized clinical trials with high-risk patients to verify the results,” said Mujaj.
In view of the frequent prescription and intake of aspirin as a blood thinner, the researchers also advocate using acetylsalicylic acid cautiously. “Our observations suggest that aspirin should be prescribed with caution, especially in patients with heart failure or risk factors,” says Mujaj. (ESC Heart Failure, 2021; doi: 10.1002 / ehf2.13688)
Quelle: European Society of Cardiology (ESC)