People who have both Type 2 diabetes and heart failure (HF) may have a lower risk of death or hospitalization for HF if they take an aspirin each day, according to research that will be presented at ACC.18 in Orlando. However, aspirin use in these patients could also increase the risk of a nonfatal heart attack or stroke.

Charbel Abi Khalil, MD, PhD, FACC, et al., extracted health records of more than 12,000 patients ages 55 and older who had Type 2 diabetes and HF but no prior history of heart attack, stroke, peripheral artery disease or atrial fibrillation. Roughly half had been prescribed daily aspirin and half had not. The researchers analyzed health outcomes over an average of five years, tracking all-cause mortality and hospitalization for HF as a primary outcome. In addition, the researchers separately tracked all-cause mortality, hospitalization for HF, major bleeding evens, and nonfatal heart or stroke as secondary outcomes. Results showed that participants who took a daily aspirin had a 10 percent decrease in the primary outcome, no difference in major bleeding events, and a 50 percent increase in nonfatal heart attack or stroke.

"We were surprised to see a paradoxical increase in nonfatal heart attacks and nonfatal stroke, parallel to the decrease in mortality," said Abi Khali. "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."

The study is the first to assess aspirin as a preventive measure for patients who have both diabetes and HF. According to the researchers, further studies could help confirm the findings and provide additional information about the risks and benefits of aspirin use in this patient population.

"While interesting, this is an observational study and can only be considered 'hypothesis generating.' It needs verification in additional research, preferably a randomized trial," said Kim A. Eagle, MD, MACC, editor-in-chief of ACC.org.

Keywords: ACC18, ACC Annual Scientific Session, Aged, Aspirin, Atrial Fibrillation, Peripheral Arterial Disease, Diabetes Mellitus, Type 2, Stroke, Myocardial Infarction, Heart Failure, Hemorrhage, Hospitalization, Risk Assessment

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