Aspirin as Effective as Warfarin for Heart Failure: Study

HealthDay – 3 hrs ago WEDNESDAY, May 2 (HealthDay News) -- Aspirin is just as effective as the blood-thinner warfarin in preventing stroke and death in heart failure patients with a normal heart rhythm, a landmark study indicates.

Although the two treatments are equally effective, researchers from Columbia University in New York City said their findings could prompt more doctors and patients to choose aspirin because it is much cheaper.

The 10-year study was the largest comparison of aspirin and warfarin (Coumadin) in the treatment of heart failure patients. In conducting the comparison, researchers followed more than 2,300 patients in 11 countries on three continents. Study participants were assigned randomly either to aspirin or warfarin, and neither the patient nor their doctor knew which medication each patient was taking.

The investigators found that the combined risk of death, stroke and cerebral hemorrhage during the study period was 7.47 percent for patients taking warfarin and 7.93 percent for patients taking aspirin -- a difference that is statistically insignificant.

Although patients taking warfarin had a nearly 50 percent lower risk for stroke than those taking aspirin, their risk for major bleeding was twice as high. As a result, the researchers argued that the benefits do not outweigh the risks. They noted, however, that taking warfarin for four years or more may be more effective at preventing stroke and death.

"With at least 6 million Americans -- and many more around the world -- suffering from heart failure, the results of the ... study will have a large public health impact," Dr. Walter Koroshetz, deputy director of the U.S. National Institute of Neurological Disorders and Stroke, said in a Columbia University news release. "Patients and their physicians now have critical information to help select the optimum treatment approach. The key decision will be whether to accept the increased risk of stroke with aspirin or the increased risk of primarily gastrointestinal hemorrhage

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Common Blood Pressure Drug Safe for Heart Failure: Study

HealthDay – 4 mins 46 secs ago TUESDAY, April 10 (HealthDay News) -- Although research has suggested that the blood pressure drug losartan (Cozaar) may be tied to an increased risk of death in heart-failure patients compared to a similar medication, a new study finds that's not the case.

"Use of this and other similar drugs has been shown to reduce morbidity and mortality in patients with heart failure," said Dr. Gregg Fonarow, co-director of the Preventative Cardiology Program at the University of California, Los Angeles, and director of the Ahmanson-UCLA Cardiomyopathy Center, commenting on the study results.

An earlier observational study in patients with heart failure suggested that losartan was associated with higher risk of death compared to the drug candesartan (Atacand), he said.

"There were, however, a number of limitations to this prior study that could have biased these results, including differences in dosing and treating physicians," said Fonarow, who was not involved in the studies.

The new research, conducted in Denmark, finds no meaningful difference in survival among heart failure patients treated with losartan or candesartan, he said.

"This study also finds for both agents that the use of higher doses, as recommended in guidelines, is associated with better outcomes than the use of lower doses," Fonarow said.

The report was published in the April 11 issue of the Journal of the American Medical Association.

Heart failure, also called congestive heart failure, means the heart is unable to pump blood to the rest of the body the way it should.

For the study, Henrik Svanstrom, from the Statens Serum Institute in Copenhagen, and colleagues collected data on nearly 6,500 heart failure patients who had recently started taking losartan (4,397 patients) or candesartan (2,082 patients).

Both are a type of drug called angiotensin II receptor blockers (ARBs).

During follow-up, 2,378 participants died -- 330 taking candesartan and 1,212 patients taking losartan, the researchers found.

However, there was no significant increased risk of all-cause death or cardiovascular death associated with losartan compared to candesartan, the researchers said.

But dosage was important, the team said. The study found twice the risk of death with low-dose losartan compared to high-dose candesartan. Medium-dose losartan and low-dose candesartan also had a higher risk of death, but high-dose losartan had no increased death risk compared to high doses of candesartan.

"Our data provide a more detailed insight into the complexity of the association between losartan use and mortality risk in heart failure," the researchers concluded.

"These findings do not support the hypothesis of differential effects of specific ARBs in patients with heart failure," they added.

Dr. David Friedman, chief of heart failure services at North Shore-LIJ Health System's Plainview Hospital in Plainview, N.Y., said, "These medications are very helpful in heart failure patients."

Friedman noted that those in the losartan group were older and sicker, which may explain why more of them died.

These patients could only tolerate lower doses of losartan, and because they were sicker they were more likely to die than patients who could tolerate higher starting doses of candesartan, he said.

More information

For more on heart failure, visit the American Heart Association.

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