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Aspirin use associated with higher risk of incident fatal and non-fatal HF
Literature - Mujaj B, Zhang ZY, Yang WY et al. - ESC Heart Fail. 2021 Nov 22. doi: 10.1002/ehf2.13688.

Introduction and methods

Aim of the study

The effects of aspirin use on HF are uncertain [1,2]. This study investigated the association between aspirin use and incident HF in a large sample of patients at risk of HF.

Study design

The study used data from 30 827 participants at risk of HF who were enrolled in 6 studies. These studies provided information on use of aspirin at baseline and on incident HF during follow-up. Average age of the participants was 66.8±9.2 years, 33.9% were women, and 24.9% were treated with aspirin at baseline. All participants were free of HF at baseline. Median follow-up was 5.3 years (5th to 95th percentile interval: 2.1 to 11.7 years).

Primary outcome

The primary outcome was fatal and non-fatal HF.

Main results

  • Aspirin use was associated with a higher risk of incident fatal and non-fatal HF (fully adjusted HR in complete dataset: 1.26, 95% CI 1.12-1.41, P<0.001).
  • Results were similar in a propensity score matched analysis (HR 1.26, 95% CI 1.10-1.44, P<0.001), in a subgroup of patients (n=22,690, 73.6%) without a history of CVD (HR 1.27, 95% CI 1.10-1.46, P=0.001) and in an analysis that excluded participants with incident HF within 2 years of enrolment (HR 1.23, 95% CI 1.06-1.41, P=0.004).
  • Interaction analyses showed that risk for incident HF with aspirin use was greater in patients not on diuretics at baseline compared to those on diuretics and in patients on statin therapy compared to those not on statins (P value for interaction= 0.02 and 0.04, respectively).


This study showed that among participants at risk of developing HF, aspirin use was associated with an increased risk of incident HF. The authors of the article state that: ‘In the absence of conclusive trial evidence, our observations suggest that aspirin should be prescribed with caution in patients at risk of HF or having HF.’


1. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomized trials. Lancet. 2009; 373: 1849–1860.

2. Cleland JG. Is aspirin useful in primary prevention? Eur Heart J 2013; 34:3412–3418.

Find this article online at ESC Heart Fail.

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