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Aspirina nello scompenso cardiaco

Aspirina sì o no nello scompenso cardiaco? E' una controversia che dura da tempo. L'aspirina è raccomandata nei pazienti con cardiopatia ischemica, nei diabetici ad alto rischio, nelle malattie vascolari e, in seconda linea, nella fibrillazione atriale, tutte condizioni frequentemente associate allo scompenso cardiaco. Ma molti studi sull'aspirina nello scompenso hanno dato risultati non positivi, anche per un aumento del rischio di ospedalizzazione per lo più sostenuto dagli effetti collaterali dell'aspirina, in particolare sull'apparato gastroenterico. E' probabile che questo fosse dovuto alla dose di aspirina utilizzata, almeno è così che si potrebbe interpretare il conflitto con quanto emerge invece dallo studio retrospettivo della Bermingham e coll. che documenta una riduzione della mortalità nei pazienti con scompenso cardiaco quando questi vengono trattati con dosi di aspirina di 75 mg.

Aspirin use in heart failure: is low-dose therapy associated with mortality and morbidity benefits in a large community population?

Bermingham M, Shanahan MK, O'Connell E, Dawkins I, Miwa S, O'Hanlon R, Gilmer J, McDonald K, Ledwidge M

Circ Heart Fail. 2014;7:243-50

BACKGROUND: Aspirin use in heart failure (HF) is controversial. The drug has proven benefit in comorbidities associated with HF; however, retrospective analysis of angiotensin-converting enzyme inhibitor trials and prospective comparisons with warfarin have shown increased risk of morbidity with aspirin use. This study aims to evaluate the association of low-dose aspirin with mortality and morbidity risk in a large community-based cohort.
METHODS AND RESULTS: This was a retrospective cohort study of patients attending an HF disease management program. Aspirin use at baseline and its association with mortality and HF hospitalization in the population was examined. Of 1476 patients (mean age, 70.4±12.4 years; 63% men), 892 (60.4%) were prescribed aspirin. Low-dose aspirin (75 mg/d) was prescribed to 828 (92.8%) patients. Median follow-up time was 2.6 (0.8-4.5) years. During the follow-up period, 464 (31.4%) patients died. In adjusted analysis, low-dose aspirin use was associated with reduced mortality risk compared with nonaspirin use (hazard ratio=0.58; 95% confidence interval, 0.46-0.74), and this was confirmed by a propensity-matched subgroup analysis. Low-dose aspirin use was associated with reduced risk of HF hospitalization compared with nonaspirin use in the total population (adjusted hazard ratio=0.70; 95% confidence interval, 0.54-0.90). In adjusted analysis, there was no difference in mortality or HF hospitalization between high-dose aspirin users (>75 mg/d) and nonaspirin users.
CONCLUSIONS: In this study, low-dose aspirin therapy was associated with a significant reduction in mortality and morbidity risk during long-term follow-up. These results suggest that low-dose aspirin may have a continuing role in secondary prevention in HF and underline the need for more trials of low-dose aspirin use in HF.

Circ Heart Fail. 2014;7:243-50