CLINICAL STUDIES
Aspirin and mortality in patients treated with angiotensin-converting enzyme inhibitors
A cohort study of 11,575 patients with coronary artery disease
Jonathan Leor, MD, FACC*,
Henrietta Reicher-Reiss, MD, FACC ,
Uri Goldbourt, PhD,
Valentina Boyko, MSc,
Shmuel Gottlieb, MD,
Alexander Battler, MD, FACC* and
Solomon Behar, MD
* Cardiology Department, Soroka Medical Center, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
Neufeld Cardiac Research Institute, Tel Aviv University, Tel Hashomer, Israel
Manuscript received October 15, 1998;
revised manuscript received January 25, 1999,
accepted February 24, 1999.
Reprint requests and correspondence: Dr. Jonathan Leor, Cardiology Department, Soroka Medical Center, POB 151, Beer Sheva 84105, Israel
jleor{at}bgumail.bgu.ac.il
OBJECTIVES
The purpose of this study was to investigate the significance of the possible negative interaction between aspirin and angiotensin-converting enzyme (ACE) inhibitors.
BACKGROUND
Several provocative reports have recently suggested that aspirin is unsafe in patients with heart failure and has negative interaction with ACE inhibitors that might attenuate their beneficial effects upon survival.
METHODS
We analyzed mortality data of 11,575 patients with coronary artery disease screened for the Bezafibrate Infarction Prevention trial. A total of 1,247 patients (11%) were treated with ACE inhibitors. Of them, 618 patients (50%) used aspirin.
RESULTS
Five-year mortality was lower among patients on ACE inhibitors and aspirin than patients on ACE inhibitors without aspirin (19% vs. 27%; p < 0.001). After adjusting for confounders, treatment with aspirin and ACE inhibitors remained associated with lower mortality risk than using ACE inhibitors only (relative risk [RR] = 0.71; 95% confidence interval [CI] = 0.56 to 0.91). Subgroup analysis of 464 patients with congestive heart failure treated with ACE inhibitors revealed 221 patients (48%) on aspirin and 243 patients not on aspirin. Although clinical characteristics and therapy were similar, patients taking aspirin experienced lower mortality than patients who did not (24% vs. 34%; p = 0.001). After adjustment, treatment with aspirin was still associated with lower mortality (RR = 0.70; 95% CI = 0.49 to 0.99).
CONCLUSIONS
Among coronary artery disease patients with and without heart failure who are treated with ACE inhibitors, the use of aspirin was associated with lower mortality than treatment without aspirin. Our findings contradict the claim that aspirin attenuates the beneficial effect of ACE inhibitors and supports its use in patients with coronary artery disease treated with ACE inhibitors.
|
Abbreviations and Acronyms
| | ACE | = angiotensin-converting enzyme | | BIP | = Bezafibrate Infarction Prevention | | CI | = confidence interval | | MI | = myocardial infarction | | RR | = relative risk |
|
This article has been cited by other articles:
|
|
|
|
 
A. T. Chan, J. E. Manson, D. Feskanich, M. J. Stampfer, G. A. Colditz, and C. S. Fuchs
Long-term Aspirin Use and Mortality in Women
Arch Intern Med,
March 26, 2007;
167(6):
562 - 572.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A. McAlister, W. A. Ghali, Y. Gong, J. Fang, P. W. Armstrong, and J. V. Tu
Aspirin Use and Outcomes in a Community-Based Cohort of 7352 Patients Discharged After First Hospitalization for Heart Failure
Circulation,
June 6, 2006;
113(22):
2572 - 2578.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. P. Brunner-La Rocca
Interaction of Angiotensin-Converting Enzyme Inhibition and Aspirin in Congestive Heart Failure: Long Controversy Finally Resolved?
Chest,
October 1, 2003;
124(4):
1192 - 1194.
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Aumegeat, N. Lamblin, P. de Groote, E. P. Mc Fadden, A. Millaire, C. Bauters, and J.-M. Lablanche
Aspirin Does Not Adversely Affect Survival in Patients With Stable Congestive Heart Failure Treated With Angiotensin-Converting Enzyme Inhibitors
Chest,
October 1, 2003;
124(4):
1250 - 1258.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Guazzi, R. Brambilla, G. Reina, G. Tumminello, and M. D. Guazzi
Aspirin-Angiotensin-Converting Enzyme Inhibitor Coadministration and Mortality in Patients With Heart Failure: A Dose-Related Adverse Effect of Aspirin
Arch Intern Med,
July 14, 2003;
163(13):
1574 - 1579.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Colwell and R. W. Nesto
The Platelet in Diabetes: Focus on prevention of ischemic events
Diabetes Care,
July 1, 2003;
26(7):
2181 - 2188.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K Dubey, D K Balani, and K K Pillai
Potential adverse interaction between aspirin and Lisinopril in hypertensive rats
Human and Experimental Toxicology,
March 1, 2003;
22(3):
143 - 147.
[Abstract]
[PDF]
|
|
|
|
|
|
|
P A Poole-Wilson, B F Uretsky, K Thygesen, J G F Cleland, B M Massie, and L Ryden
Mode of death in heart failure: findings from the ATLAS trial
Heart,
January 1, 2003;
89(1):
42 - 48.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Lindenfeld, A. D. Robertson, B. D. Lowes, M. R. Bristow, and for the MOCHA Investigators
Aspirin impairs reverse myocardial remodeling in patients with heart failure treated with beta-blockers
J. Am. Coll. Cardiol.,
December 1, 2001;
38(7):
1950 - 1956.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. A. Gum, M. Thamilarasan, J. Watanabe, E. H. Blackstone, and M. S. Lauer
Aspirin Use and All-Cause Mortality Among Patients Being Evaluated for Known or Suspected Coronary Artery Disease: A Propensity Analysis
JAMA,
September 12, 2001;
286(10):
1187 - 1194.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Latini, G. Tognoni, A. P. Maggioni, C. Baigent, E. Braunwald, Z.-M. Chen, R. Collins, M. Flather, M. Franzosi, J. Kjekshus, et al.
Clinical effects of early angiotensin-converting enzyme inhibitor treatment for acute myocardial infarction are similar in the presence and absence of aspirin: Systematic overview of individual data from 96,712 randomized patients
J. Am. Coll. Cardiol.,
June 1, 2000;
35(7):
1801 - 1807.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Levi, R. Maruyama, N. C. E. Smith, and N. Seyedi
Is the lower mortality in patients treated with aspirin and angiotensin-converting enzyme inhibitors due to decreased norepinephrine release?
J. Am. Coll. Cardiol.,
March 1, 2000;
35(3):
817 - 818.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Leor, S. Gottlieb, and S. Behar
Reply
J. Am. Coll. Cardiol.,
March 1, 2000;
35(3):
818 - 819.
[Full Text]
[PDF]
|
|
|
|
|
|
|
ACE Inhibitors Plus Aspirin Improve Survival Rates
Journal Watch Cardiology,
August 13, 1999;
1999(813):
4 - 4.
[Full Text]
|
|
|
|
|
|
|
The Combination of ASA and ACE Inhibitors Appears Safe
Journal Watch Emergency Medicine,
August 1, 1999;
1999(801):
8 - 8.
[Full Text]
|
|
|
|
