Study: Aspirin OK for Heart Patients

C H I C A G O, Feb. 26, 2001 -- Heart attack victims can safely take aspirin witha blood pressure-lowering drug to aid their recovery, but combiningthe treatments is only slightly more effective than using just one,Yale University researchers report.

The findings may ease concerns that combining aspirin with ACEinhibitors could be ill-advised for some patients with hearttrouble. Previous studies have suggested that the combination couldresult in kidney impairment or impair the effectiveness of ACEinhibitors.

"We could find no evidence of an adverse interaction," Dr.Harlan M. Krumholz and colleagues, the new study's authors, said intoday's Archives of Internal Medicine.

A related Krumholz study published in the same journal suggeststhat aspirin can safely be used to lower mortality in heart failurepatients.

Both studies involved patients ages 65 and older.

Aspirin, which improves blood flow through the arteries bymaking it less sticky and less likely to clot, often is recommendedto help prevent and treat heart problems. But its use has beenquestioned in patients with heart failure who do not haveclot-related coronary artery disease.

Better Blood Pumping

ACE inhibitors, which lower blood pressure and help the heartpump more efficiently, often are recommended for such patients,said Dr. David A. Meyerson, a cardiologist at Johns HopkinsUniversity and spokesman for the American Heart Association.

Some doctors may be reluctant to prescribe aspirin for heartfailure patients without clot-related disease partly due toconcerns that it might hamper the effectiveness of ACE inhibitors,Meyerson said.

The second study, involving 1,100 Medicare heart-failurepatients hospitalized in Connecticut, reported an overall 29percent lower mortality risk one year later for those who wereprescribed aspirin at hospital discharge. Some patients also tookACE inhibitors but the interaction of the two medications was notthe focus of the study.

While it's unclear how aspirin improved survival chances in theheart failure patients, the results "suggest that one of oursimplest medications continues to be one of the most valuable,"Meyerson said. "The survival benefits appear significant."

Meyerson said the AHA will evaluate whether to add aspirin totreatment guidelines for older heart failure patients withoutclot-related cardiovascular disease.

Its existing guidelines for heart attack patients recommendcombining aspirin and ACE inhibitors.

In Krumholz' study of 14,129 heart attack survivors, the drugswere equally effective taken separately, reducing patients' chancesof dying within a year of a heart attack by about 15 percent.Patients who used both drugs together fared slightly but notsignificantly better, the authors said.

"This topic has great importance, since some physicians may bedeparting from the guidelines because of a concern about an adverseinteraction," Krumholz and his colleagues wrote. "The results ofthis study suggest that the current guidelines need not bealtered."