SAN FRANCISCO – Does use of aspirin increase heart failure (HF) hospitalization or risk of death in patients with reduced ejection fraction receiving an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB)?

That was the question addressed in a recent article in the journal JACC Heart Failure. The report pointed out that aspirin has been postulated to increase HF events in patients treated with ACE inhibitors or ARBs because of its cyclooxygenase inhibiting properties.1

The study team led by researchers from the San Francisco VAMC and the University of California San Francisco School of Medicine pointed out, however, that no large randomized trial has addressed the clinical relevance of this issue.

To help remedy the information deficit, researchers compared aspirin and warfarin for HF events — hospitalization, death, or both — in the 2,305 patients enrolled in the Warfarin vs. Aspirin in Reduced Cardiac Ejection Fraction (WARCEF)) trial. Nearly all of the patients were on ACE inhibitor or ARB treatment.

Overall, 432 HF hospitalization events occurred with aspirin — 10.7 per 100 patient-years — compared to 500 HF hospitalization events with warfarin — 12.4 per 100 patient-years. Study authors calculated the risk ratio at 0.87.

Even though, at a mean follow-up of 3.5 years, a much lower percentage of the aspirin group reached the combined outcome of hospitalization or death attributed to HF than the warfarin group — 19% vs. 23% — after adjustment for patient characteristics, researchers determined that the groups did not differ in risk for the combined outcome or for HF hospitalization alone, for an adjusted hazard ratio of 0.87 or first hospitalization alone (adjusted hazard ratio: 0.88).

“Among patients with HF with reduced ejection fraction in the WARCEF trial, there was no significant difference in risk of HF events between the aspirin and warfarin-treated patients. (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction trial [WARCEF],” the researchers concluded. 

1.    Teerlink JR, Qian M, Bello NA, Freudenberger RS, Levin B, Di Tullio MR, GrahamS, Mann DL, Sacco RL, Mohr JP, Lip GYH, Labovitz AJ, Lee SC, Ponikowski P, LokDJ, Anker SD, Thompson JLP, Homma S; WARCEF Investigators. Aspirin Does NotIncrease Heart Failure Events in Heart Failure Patients: From the WARCEF Trial.JACC Heart Fail. 2017 Aug;5(8):603-610. doi: 10.1016/j.jchf.2017.04.011. PubMedPMID: 28774396; PubMed Central PMCID: PMC5570544.