Aspirin Lowers Risk of Death But Increases Nonfatal MI, Stroke in Patients with T2D, HF

Charbel Abi Khalil, MD, PhD, Weill Cornell Medicine-Qatar

Charbel Abi Khalil, MD, PhD

Research presented at the American College of Cardiology’s 67^th Annual Scientific Session concluded that taking an aspirin each day appears to lower the risk of mortality or being hospitalized for heart failure in patients living with type 2 diabetes and heart failure, however, it was found to increase the risk of nonfatal myocardial infarction (MI) or stroke.

This is the first study to assess aspirin as a preventive measure for patients with both diabetes and heart failure.

“We are surprised to see a paradoxical increase in nonfatal heart attacks and nonfatal stroke, parallel to the decrease in mortality,” study author Charbel Abi Khalil, MD, PhD, Weill Cornell Medicine-Qatar said. “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.”

While aspirin is strongly recommended for those with a previously reported MI or stroke, guidelines are unclear regarding its use as a preventive measure for those with cardiovascular risk factors but no history MI or stroke.

In previous studies, researchers found that those without those types of health events have shown conflicting evidence of aspirin’s potential benefits in the general population. Some studies have suggested that in patients with heart failure, a daily aspirin may be harmful.

Researchers used data from the United Kingdom database, The Health Improvement Network (THIN), extracting health records of more than 12,000 patients ages 55 and older with type 2 diabetes and heart failure but no prior history of MI, stroke, peripheral artery disease or atrial fibrillation.

Roughly half of the population were prescribed daily aspirin and half had not. Of the trial participants, 5967 patients were taking aspirin — 137 patients used doses >75 mg — and 6567 were not taking aspirin.

During the 5.2 years of follow-up, researchers compared outcomes for those on aspirin to no-aspirin after the diagnosis of heart failure.

The primary outcome was tracked as all-cause mortality and hospitalization for heart failure, while all-cause mortality, hospitalization for heart failure, major bleeding events and nonfatal MI or stroke were tracked separately as secondary outcomes.

Results concluded that those taking daily aspirin were found to show a 10% decrease in the primary outcome, no difference in major bleeding events and a 50% increase in nonfatal MI or stroke.

After a multivariable adjustment in a cox-regression model, aspirin was significantly associated with a decrease in the primary outcome (HR 0.89;95%CI:0.84-0.94).

There was no additional benefit for a >75 mg dose of aspirin.

The study sheds new light on potential risks and benefits of aspirin for people with both conditions and it’s recommended that doctors assess the benefits and risks of taking aspirin with patients.

Study research is limited in that it was based on a retrospective analysis of health records as opposed to a randomized controlled trial.

Future studies are needed in order to help confirm the findings, further elucidate the risks and benefits of aspirin use in this specific patient population and potentially inform specific guidelines for treatment of patients with diabetes and heart failure.

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