Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors.
BACKGROUND
By inhibiting prostaglandins, aspirin may be deleterious in heart failure (HF) and/or may counteract angiotensin-converting enzyme (ACE) inhibitor efficacy. Conversely, clopidogrel has no effect on prostaglandin metabolism.


OBJECTIVE
To investigate the effect of aspirin and clopidogrel on brain natriuretic peptide (BNP) levels in HF patients treated with ACE inhibitors.


METHODS
36 patients with stable HF (65+/-13 years, 24 males/12 females, NYHA class II to IV, ejection fraction <40%, 13 with coronary disease, all treated with ACE inhibitors) were enrolled in this prospective, double-blind study and randomised to aspirin 325 mg/day or clopidogrel 75 mg/day for 14 days. BNP was determined at day 0 and day 14.


RESULTS
19 patients were randomised to aspirin and 17 to clopidogrel. Baseline characteristics were similar in both groups. BNP levels increased in the aspirin group from day 0 to day 14 (107+/-103 to 144+/-149 pg/ml, p=0.04) whereas clopidogrel had no effect (104+/-107 and 97+/-99 pg/ml respectively, p=0.61).


CONCLUSIONS
This study demonstrates an adverse effect of aspirin 325 mg/day on BNP plasma levels in HF patients treated with ACE inhibitors. In contrast clopidogrel 75 mg/day had no effect.
Meune
Christophe
C
Department of Cardiology, Cochin Hospital, Paris, France. christophe.meune@cch.ap-hop-paris.fr
Wahbi
Karim
K
Fulla
Yvonne
Y
Cohen-Solal
Alain
A
Duboc
Denis
D
Mahé
Isabelle
I
Simoneau
Guy
G
Bergmann
Jean-François
JF
Weber
Simon
S
Mouly
Stéphane
S
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000809:Angiotensins / Q000187:drug effects; D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology*; D000077144:Clopidogrel; D005260:Female; D006333:Heart Failure / Q000097:blood* / Q000188:drug therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood* / Q000187:drug effects; D011453:Prostaglandins; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000494:pharmacology
D000806:Angiotensin-Converting Enzyme Inhibitors; D000809:Angiotensins; D011453:Prostaglandins; D020097:Natriuretic Peptide, Brain; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin