Key result
The use of ACE inhibitors in heart failure patients was associated with a high risk for the presence of anaemia (RR 17.4), with perindopril posing more risk (RR 20.8) than ramipril.
Why the study?
The extent of anaemia in heart failure and particularly the role of heart failure therapy itself as a risk factor were not fully understood.
Does the use of ACE inhibitors and higher doses of aspirin increase the risk of anaemia in patients with heart failure?
Cohort (n=96)
Does the use of ACE inhibitors and higher doses of aspirin increase the risk of anaemia in patients with heart failure?
Relative Risk: 17.4
In patients with heart failure, the use of ACE inhibitors (especially perindopril) and higher doses of aspirin (150mg vs 100mg) are significant risk factors for the development of anaemia.
ACE inhibitor use may raise anaemia risk in heart failure; hypothesis-generating and should not change practice without randomized confirmation.
BACKGROUND: Patients with heart failure often have comorbidities that alter the progression of heart failure and impact on prognosis. One such comorbidity is anaemia, and clinicians have started to appreciate the full gravity of its impact on heart failure patients. Yet, the extent of the problem is not fully understood, particularly the role of heart failure therapy itself as a risk factor for developing anaemia. OBJECTIVE: This study aimed to investigate the prevalence of anaemia in a cohort of heart failure patients. The impact of using different ACEIs and different doses of aspirin was also explored, together with the prevalence of haematinic deficiencies. METHODS: Medication lists and pathology results were examined to establish the prevalence of ACEIs use, and the use of aspirin at its most common doses of 100mg and 150mg, together with haematinic deficiencies. Multinomial logistic regression and the Student's t-test were utilised for the analysis of data. Statistical significance was pre-set at p<0.05. RESULTS: Ninety-six patients were eligible for analysis, with 26% having anaemia. The use of ACEIs had a RR of 17.4 for the presence of anaemia. Perindopril was associated with a RR of 20.8, while the use of ramipril was not significantly associated with such a high RR. Haematinic anaemia occurred only at a rate of 3.3%, but borderline deficiencies were found in more than a third of all patients. An aspirin dose of 150mg was associated with a higher risk for anaemia, compared to a dose of 100mg. CONCLUSIONS: ACEIs are associated with the presence of anaemia, with perindopril posing more risk than ramipril when used in heart failure patients. The dose of aspirin may also be a factor in the development of anaemia, with lower doses being safer. Despite the lack of high prevalence of haematinic anaemia among this cohort of patients, borderline haematinic deficiencies were common.
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Kyrillos Guirguis (2019) conducted a cohort in heart failure (n=96). ACE inhibitors and aspirin vs. Unexposed or lower dose was evaluated on Presence of anaemia (RR 17.4). The use of ACE inhibitors in heart failure patients was associated with a high risk for the presence of anaemia (RR 17.4), with perindopril posing more risk (RR 20.8) than ramipril.
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