Aspirin Use May Increase Heart Failure Risk Regardless of Previous CVD

Researchers assessed the effects of aspirin use and whether it raises the risk of incident heart failure (HF) in patients at risk for the condition.

The risk for heart failure (HF) may increase with aspirin use regardless of previous cardiovascular disease (CVD), according to a study published in ESC Heart Failure.

Researchers conducted a patient-level pooled analysis with 30,827 participants (33.9% women; mean age 66.8±9.2 years; 21.5% with diabetes; 26.4% current smokers; and 66.7% consumed alcohol) from 6 observational studies, all of whom were considered at risk for HF. Baseline cardiovascular risk factors were recorded, and follow-up endpoints included incident fatal and nonfatal HF. Multivariable-adjusted proportional hazard regression was used to assess the correlation between aspirin use and incident HF, with adjustments for cardiovascular risk factors.

Over a median follow-up period of 5.3 years (5th-95th percentile interval, 2.1-11.7), HF occurred in 1330 participants. This resulted in a fully adjusted hazard ratio (HR) of 1.26 (95% CI, 1.12-1.41; P <.001). When results were analyzed with propensity score matching, the HR remained 1.26 (95% CI, 1.10-1.44; P <.001). Among the 73.6% (n=22,690) of participants with no CVD history, the HR was 1.27 (95% CI, 1.10-1.46; P =.001).

Limitations to this study include an inability to analyze dose effect or medication intake as a time-dependent variable, a lack of information on adherence or ejection fraction, and residual confounding.

“Aspirin use is associated with an increased risk of HF in patients receiving aspirin with or without a previous history of CVDs,” the study authors said. “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.”


Mujaj B, Zhang ZY, Yang WY, et al. Aspirin use is associated with increased risk for incident heart failure: a patient-level pooled analysis. ESC Heart Fail. Published online November 22, 2021. doi:10.1002/ehf2.13688