Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology & Preventive Medicine, Monash University, Melbourne, Australia.
London School of Hygiene and Tropical Medicine, London, UK.
Eur J Heart Fail. 2016 Sep;18(9):1175-81. doi: 10.1002/ejhf.485. Epub 2016 Feb 2.
It is not known whether concomitant use of aspirin might attenuate the beneficial effects of mineralocorticoid receptor antagonists (MRAs). The purpose of this subgroup analysis was to explore the interaction between baseline aspirin treatment and the effect of eplerenone on the primary efficacy outcomes (composite of hospitalization for heart failure or cardiovascular mortality), its components, and safety markers [estimated glomerular filtration rate (eGFR), systolic blood pressure (SBP), and serum potassium >5.5 mmol/L] in the Eplerenone in Mild Patients Hospitalization and SurvIval Study in Heart Failure trial (EMPHASIS-HF).
Patients with chronic heart failure, reduced ejection fraction (HFREF), and mild symptoms were enrolled in EMPHASIS-HF. We evaluated baseline characteristics according to aspirin use. We explored the interaction between aspirin and eplerenone, using Cox proportional hazards models providing adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) and P-values for interaction. Of the 2737 patients randomized, 1605 patients (58.6%) were taking aspirin. The beneficial effects of eplerenone on the primary endpoint were similar in patients not treated (adjusted HR 0.59, 95% CI 0.46-0.75) or treated (adjusted HR 0.71, 95% CI 0.59-0.87) with aspirin at baseline (interaction P-value = 0.19). We did not observe any significant modification of the safety markers by aspirin that was clinically meaningful.
Aspirin use in patients with chronic systolic heart failure and mild symptoms did not substantially reduce the overall beneficial effects of the MRA eplerenone contrary to what has been described in some studies with ACE inhibitors.
目前尚不清楚同时使用阿司匹林是否会减弱盐皮质激素受体拮抗剂（MRA）的有益作用。本亚组分析的目的是探讨基线阿司匹林治疗与依普利酮对主要疗效终点（心力衰竭住院或心血管死亡率的复合终点）、其组成部分和安全性标志物（估计肾小球滤过率[eGFR]、收缩压[SBP]和血清钾>5.5mmol/L）的影响之间的相互作用，依普利酮在心力衰竭轻度患者住院和生存研究（EMPHASIS-HF）中。
患有慢性心力衰竭、射血分数降低（HFREF）和轻度症状的患者被纳入 EMPHASIS-HF。我们根据阿司匹林的使用情况评估了基线特征。我们使用 Cox 比例风险模型评估了阿司匹林和依普利酮之间的相互作用，提供了调整后的危险比（HR）及其 95%置信区间（CI）和交互 P 值。在 2737 名随机患者中，1605 名患者（58.6%）正在服用阿司匹林。依普利酮对主要终点的有益作用在未接受治疗的患者（调整后的 HR 0.59，95%CI 0.46-0.75）或基线时接受阿司匹林治疗的患者（调整后的 HR 0.71，95%CI 0.59-0.87）中相似（交互 P 值=0.19）。我们没有观察到阿司匹林对安全性标志物有任何有临床意义的显著改变。
在慢性收缩性心力衰竭和轻度症状的患者中使用阿司匹林并没有显著降低 MRA 依普利酮的总体有益作用，这与一些 ACE 抑制剂研究中描述的情况相反。
