A new study published in ESC Heart Failure has found that aspirin use is associated with a 26% raised risk of heart failure in people with at least one predisposing factor for the condition, including smoking, obesity, high blood pressure, high cholesterol, diabetes, and cardiovascular disease. 

The analysis included more than 30,000 individuals who were at risk of developing heart failure and enrolled in the Western Europe and the US into the HOMAGE study.

The average age of participants was 67 years and 34% were women. All participants were free of heart failure at baseline. Aspirin use was recorded at enrolment and participants were classified as users or non-users.

Taking aspirin was associated with a 26% raised risk of a new heart failure diagnosis

At baseline, a total of 7,698 participants (25%) were taking aspirin. During the 5.3-year follow-up for the first incidence of fatal or non-fatal heart failure requiring hospitalisation, 1,330 participants developed the condition. 

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 and various other factors. They found that taking aspirin was independently associated with a 26% raised risk of a new heart failure diagnosis.

To check the consistency of the results, the researchers repeated the analysis after matching aspirin users and non-users 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

"Aspirin should be prescribed with caution in those with heart failure"

The study is the first to report these findings, according to study author Dr. Blerim Mujaj of the University of Freiburg, Germany. He said: "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 said the findings now need to be confirmed with further clinical trials: "Large multinational randomised 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."