Aspirin alters arterial function in patients with chronic heart failure treated with ACE inhibitors: a dose-mediated deleterious effect.
BACKGROUND
By inhibiting prostaglandin synthesis, aspirin can interfere with both arterial functional and angiotensin-converting enzyme inhibitor (ACEI) properties and be deleterious in chronic heart failure (CHF).


OBJECTIVE
Our aim was to prospectively evaluate the effect of aspirin on arterial functional properties in CHF patients treated with ACEIs.


RESULTS
Over three consecutive treatment periods of 7 days, 18 patients received placebo, followed by aspirin 100 mg/day, and then aspirin 325 mg/day. Single blind prospective assessment of reflected wave and time reflection by radial applanation tonometry; pulse wave velocity; blood pressure; thromboxane B2 (TxB2) and prostaglandins in plasma and urine was performed. Aspirin 325 mg/day induced a significant increase in augmentation index of reflected wave (P<0.0001 and P=0.0013 vs. placebo and aspirin 100 mg, respectively) and a significant decrease in reflected wave traveling times (P=0.0007 vs. placebo). Aspirin 100 mg/day produced a similar, though non-significant, trend in these parameters compared with placebo. Both aspirin treatments produced a statistically significant decrease in serum TxB2 (P<0.0001) but did not have an effect on the metabolite of prostaglandin I2 (P=0.136).


CONCLUSIONS
This study demonstrates the existence of a dose-mediated deleterious effect of aspirin upon arterial functional properties in CHF patients treated with ACEI.
Meune
Christophe
C
Internal Medicine, Hospital Lariboisière, Paris, France. christophe.meune@cch.ap-hop-paris.fr
Mahé
Isabelle
I
Mourad
Jean-Jacques
JJ
Cohen-Solal
Alain
A
Levy
Bernard
B
Kevorkian
Jean-Philippe
JP
Jondeau
Guillaume
G
Habib
Aïda
A
Lebret
Marilyne
M
Knellwolf
Anne-Laure
AL
Simoneau
Guy
G
Caulin
Charles
C
Bergmann
Jean-François
JF
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D001158:Arteries / Q000187:drug effects* / Q000503:physiopathology*; D001241:Aspirin / Q000008:administration & dosage* / Q000009:adverse effects; D001794:Blood Pressure / Q000187:drug effects; D002908:Chronic Disease; D018849:Controlled Clinical Trials as Topic; D016861:Cyclooxygenase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D003971:Diastole / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004656:Enalapril / Q000008:administration & dosage / Q000009:adverse effects; D023381:Endpoint Determination; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology*; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D017706:Lisinopril / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008365:Manometry; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D017257:Ramipril / Q000008:administration & dosage / Q000009:adverse effects; D012083:Renin / Q000097:blood / Q000187:drug effects; D015203:Reproducibility of Results; D016037:Single-Blind Method; D013599:Systole / Q000187:drug effects; D013929:Thromboxane B2 / Q000378:metabolism; D013997:Time Factors; D016896:Treatment Outcome
D000806:Angiotensin-Converting Enzyme Inhibitors; D016861:Cyclooxygenase Inhibitors; D000450:Aldosterone; D013929:Thromboxane B2; D004656:Enalapril; D017706:Lisinopril; D012083:Renin; D017257:Ramipril; D001241:Aspirin