Aspirin linked to lower mortality in patients with T2D, heart failure
The use of aspirin in older patients with type 2 diabetes (T2D) and heart failure appears to reduce mortality risk but paradoxically increases the rates of nonfatal myocardial infarction (MI) and stroke, according to a retrospective analysis of health records presented at ACC.18.
“Both heart failure and diabetes are associated with increased blood-clotting activity,” said lead author Dr Charbel Abi Khalil from Weill Cornell Medicine-Qatar, Doha, Qatar. “Because it [aspirin] decreases platelet aggregation, aspirin is thought to lower the likelihood of forming harmful blood clots like those responsible for heart attacks and strokes.”
However, the role of aspirin in primary cardiovascular (CV) risk prevention in patients with T2D has not been fully studied, while its benefit in heart failure remains controversial. To examine the impact of aspirin in T2D and heart failure, Khalil and team analysed data from The Health Improvement Network (THIN) database of patients seen in primary care in the UK.
Patients were ≥55 years with T2D and heart failure, but no prior history of MI, stroke, peripheral artery disease, or atrial fibrillation. Of the total study population of 12,534 patients, 47.6 percent were aspirin users and 52.4 percent were nonusers. Of those taking aspirin, 137 were taking higher doses (>75 mg daily). Patients on aspirin were younger and had a shorter duration of diabetes, but had a higher prevalence of hypertension and dyslipidaemia. [ACC.18, abstract 1212-432]
During a mean follow-up of 5.2 years, the primary outcome of a composite of all-cause mortality with or without hospitalization for HF was 10 percent less likely in patients treated with aspirin (hazard ratio, 0.89). However, patients taking aspirin had an increased risk for nonfatal MI (p<0.001) or stroke (p=0.03).
“We were surprised to see a paradoxical increase in nonfatal heart attacks and nonfatal stroke, parallel to the decrease in mortality,” said Khalil. “This finding might be due to the fact that those patients lived longer. Given their mean age of 70 years, perhaps these patients were predisposed to more cardiac events.”
Of note, bleeding risk was similar between groups, so were hospital admission rates.Currently, there are no specific guideline recommendations for primary prevention with aspirin in patients with T2D and heart failure. Physicians use risk calculator to evaluate having a patient’s future risk of having a CV event. “[Hence,] patients should speak with their doctors to assess the benefits and risks of taking aspirin,” Khalil said.