Abstract 3594: Lack of Interaction between Angiotensin Receptor Blocker and Aspirin in Patients with Heart Failure
Background: Prior studies have suggested a possible adverse interaction between aspirin (ASA) and ACE inhibitors on cardiovascular outcomes in pts with chronic heart failure (CHF). It is unknown whether or not there is an interaction between ASA and angiotensin receptor blockers in pts with CHF.
Objectives: We sought to assess the interaction between ASA and candesartan on morbidity and mortality in patients enrolled in the Candesartan in Heart failure Assessment of Reduction in Mortality and morbidity (CHARM) study.
Methods: We evaluated 7599 pts with symptomatic heart failure enrolled in the CHARM program according to baseline ASA use. Patients were randomized to candesartan, titrated to 32 mg daily, or placebo, and were followed for a median of 37.7 months. The primary endpoint was combined cardiovascular (CV) death or CHF hospitalization.
Results: ASA was used in 4246 (55.9%) of patients at the time of randomization. Patients on ASA were more likely to be male, had history of hypertension, diabetes, smoking, angina, myocardial infarction, revascularization and ischemic etiology of LV dysfunction. More patients not on ASA had severely depressed LVEF (< 25 %), NYHA functional class III- IV, history of hospitalization due to CHF, atrial fibrillation or pacemaker implant. Compared to placebo, candesartan use was associated with lower event rates(CV death or hosp for CHF) in both the ASA group (28 % vs. 31.9%, adjusted HR 0.81, 95% CI 0.72– 0.90) and non- ASA group (33 % vs. 38 %, adjusted HR 0.81, 95% CI 0.72– 0.91). When the interaction between treatment and ASA was tested in both univariate and multivariate Cox regression models, ASA use was not a predictor of CV death or CHF hospitalization (p=0.64 for univariate and p=0.98 for multivariate analysis). Etiology and severity of LV dysfunction had no influence on the beneficial effect of candesartan on CV death or CHF hospitalization in patients receiving baseline ASA (p =0.73 for etiology and p=0.26 for LVEF).
Conclusions: Candesartan was beneficial in reducing CV-related morbidity and mortality in pts with different degrees of LV dysfunction despite use of ASA. Therefore, there appears to be no modification of the benefit from candesartan by concomitant use of ASA.