However, Dr. Masoudi noted that while the study accounted for differences between the patients taking aspirin and those who were not, there may have been other important differences they couldn't identify. Still, Dr. Masoudi said it appears aspirin is under-used.
"Improving the use of aspirin in patients with coronary artery disease is potentially a low-cost means of improving outcomes," Dr. Masoudi said.
James E. Udelson, M.D., F.A.C.C., from Tufts-New England Medical Center, who was not connected with this study, noted that along with the longstanding concerns about aspirin's potential to harm heart failure patients, there is also the possibility that withholding aspirin could deprive certain patients of aspirin's cardiovascular benefits.
"This paper by Masoudi and colleagues adds support to the concept that aspirin has a very beneficial effect in patients with both heart failure and also coronary artery disease, in a study of a very large number of patients. While the retrospective nature of the investigation adds some limitations to the strengths of the conclusions, the data suggest that physicians should not withhold aspirin from such patients," Dr. Udelson said.
However, Barry M. Massie, M.D., F.A.C.C., from the University of California, San Francisco and the San Francisco VAMC, struck a more cautious tone in an accompanying viewpoint article, noting that the only two prospective randomized trials of this topic suggest that aspirin may be associated with worsening heart failure in some patients. The studies reported 30 percent higher rates of hospitalization among patients on aspirin compared to those receiving warfarin or no therapy. This difference might be explained by the inhibition of prostaglandins, which play a role in counterbalancing the adverse effects of neurohormonal activation on blood flow and, possibly, kidney function in heart failure patients.
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Contact: Anne Dees
adees@acc.org
301-581-3406
American College of Cardiology
15-Sep-2005