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Doctor: Study linking aspirin, heart failure needs more analysis

By Jamie Lampros - Special to the Standard-Examiner | Dec 7, 2021

Patrick Sison, Associated Press

This Aug. 23, 2018, file photo shows an arrangement of aspirin pills in New York.

A Utah heart physician says a new study that shows a link between aspirin and heart failure might be selection bias, but it’s something worth talking about.

Selection bias can mean some conclusions of the study may be false.

The study, from the European Society of Cardiology, found that taking aspirin may raise the risk of heart failure among people with at least one pre-existing health risk that includes cardiovascular disease, high blood pressure or cholesterol, smoking, obesity and diabetes.

But Dr. Brent Muhlestein, co-director of cardiovascular research at the Intermountain Healthcare Heart Institute, said he’s never seen a case of heart failure in any of his patients taking aspirin.

“It’s an interesting finding. Sometimes we start out with these big observational studies but then we find something that brings up a question as to whether or not we need to look further into it,” he said. “I’m glad they published the study because now we’ll look at our data and see if it’s confirmatory, but it needs to be evaluated much further before we make any changes to our guidelines.”

Aspirin has been around since 1897 and has been one of the most common pain relievers in the world, but it also comes with risks.

“It’s a very effective anti-inflammatory pain control agent, but it has lots of problems with gastrointestinal distress,” Muhlestein said. “In the old days, they used to give an adult aspirin to people four times a day and it even caused people to get ringing in the ears.”

Today, however, Muhlestein said there are other drug therapies for certain conditions that were previously treated with aspirin. In addition, hundreds of studies have shown a baby aspirin can prevent further heart attacks in people who have had one before.

According to the study, aspirin has a complicated medical history. Some studies have found taking an aspirin on a regular basis can help protect against COVID-19 and cancer. Other studies have found it actually does more harm than good.

The study included 31,000 people ages 40 and over who were at risk of developing heart failure. Researchers found a 26% increase of the condition among those who used aspirin. The participants were divided into two groups — users and non-users — and were followed for five years. Influential factors such as gender, weight, alcohol use, age, medication usage and various measures of health were accounted for in the study.

Overall, 7,698 participants were using aspirin and 1,330 developed heart failure over the next five-plus years.

Researchers emphasized large, multinational randomized trials in adults at risk for heart failure are needed to verify the results. Until then, observations suggest that aspirin should be prescribed with caution in those with heart failure or with risk factors for the condition.

Muhlestein said it will be important to follow up on the findings, but for now, several studies have shown the benefits of using a baby aspirin as a secondary prevention method to stop heart attacks in people who have already had one. The American Heart Association has also stated if you don’t have coronary heart disease and you are controlling other risk factors, you probably don’t need to take aspirin.

Muhlestein also said it’s important people know the difference between primary prevention and secondary prevention. Primary prevention refers to steps taken to prevent the onset of disease. Secondary prevention includes early diagnosis and steps prescribed from medical providers to help the patient improve their quality of life. That would include treating someone who has previously suffered a heart attack or has several underlying risk factors.

“I don’t know that aspirin has ever been linked with heart failure,” he said. “There have been tons of randomized trials where they look for everything and heart failure was not listed as an increased risk.”

One of the best ways to prevent a heart attack, Muhlestein said, is to exercise, keep your blood pressure and cholesterol levels in the normal range, eat a healthy Mediterranean-style diet, quit smoking and maintain a healthy weight. If you’ve been prescribed aspirin, take it and stay in contact with your physician.

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