Studies ease concerns about aspirin therapy

Thursday, March 1st 2001, 12:00 am
By: News On 6

CHICAGO, Illinois (AP) -- Heart attack victims can safely take aspirin with a blood pressure-lowering drug to aid their recovery, but combining the treatments is only slightly more effective than using just one, Yale University researchers report.

The findings may ease concerns that combining aspirin with ACE inhibitors could be ill-advised for some patients with heart trouble. Previous studies have suggested that the combination could result in kidney impairment or impair the effectiveness of ACE inhibitors.

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

A related Krumholz study published in the same journal suggests that aspirin can safely be used to lower mortality in heart failure patients.

Both studies involved patients aged 65 and older.

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

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

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

The second study, involving 1,100 Medicare heart-failure patients hospitalized in Connecticut, reported an overall 29 percent lower mortality risk one year later for those who were prescribed aspirin at hospital discharge. Some patients also took ACE inhibitors but the interaction of the two medications was not the focus of the study.

While it's unclear how aspirin improved survival chances in the heart failure patients, the results "suggest that one of our simplest 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 to treatment guidelines for older heart failure patients without clot-related cardiovascular disease.

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

In Krumholz' study of 14,129 heart attack survivors, the drugs were equally effective taken separately, reducing patients' chances of dying within a year of a heart attack by about 15 percent. Patients who used both drugs together fared slightly but not significantly better, the authors said.

"This topic has great importance, since some physicians may be departing from the guidelines because of a concern about an adverse interaction," Krumholz and his colleagues wrote. "The results of this study suggest that the current guidelines need not be altered."