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. Aim: 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 = 0.6 1). Conclusion: 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. (c) 2006 European Society of Cardiology. Published by Elsevier B.V All rights reserved.