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Clopidogrel is associated with a lesser increase in NT-proBNP when compared to aspirin in patients with ischemic heart failure
Jug, Borut, 1975- ...
Background: Aspirin has been associated with adverse heart failure outcomes, probably because of a blunting interaction with angiotensin-converting enzyme (ACE) inhibitors. Therefore, we hypothesized ...that clopidogrel when compared with aspirin would be associated with a slower progression of heart failure asdetermined by levels of amino-terminal pro-brain natriuretic peptide (NT-proBNP). Methods and Results: In an open-label, randomized, 2-treatment, 2-period crossover study, 18 patients with ischemic heart failure (14 post-myocardial infarction, left ventricular ejection fraction 0.32 f 0.08), median age 73, New York Heart Association class II (11 patients) or III (7 patients), all taking ACE inhibitors were included. Patients were randomized to 8 weeks of aspirin 100 mg/day followed by 8 weeks of clopidogrel 75 mg/day,or the reversed sequence. Blood levels of NT-proBNP were measured usingsandwich immunoassay. Patients on aspirin experienced an 8-times greater increase in log-transformed values of NT-proBNP compared with patients on clopidogrel (average change 4.757% versus 0.597%; P = .0395 for intervention, P = .4453 for period, P = .4046 for sequence). We observed no change in functional class, 6-minute walking test, creatinine levels, or electrolytes. Conclusion: Aspirin is associated with a greater increase in natriuretic peptides (log-transformed NTproBNP levels), implying that aspirin therapy is associated with a more progressive course of heart failure.
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