Mujaj B, Zhang ZY, Yang WY, et al. - In this study, aspirin use in patients at risk was related to incident heart failure (HF), independent of other risk factors. In the absence of conclusive trial evidence, prescribing aspirins with caution in patients at risk of HF or having HF is advised.

• Little or no benefit of aspirin in the primary prevention of cardiovascular disease has been revealed in recent trials.

• From six observational studies, data from 30,827 patients at risk for HF were studied [women 33.9%, mean age (±standard deviation) 66.8 ± 9.2 years], to assess the role of aspirin use on HF incidence in primary and secondary prevention and if aspirin use elevates the risk of incident HF in patients at risk.

• HF occurred in 1,330 patients during 5.3 years, and the fully adjusted hazard ratio (HR) linked with aspirin use was 1.26 [95% confidence interval (CI) 1.12–1.41; P ≤ 0.001].

• A HR of 1.26 (95% CI 1.10–1.44; P ≤ 0.001) was revealed in a propensity-score-matched analysis.

• The estimated HR was 1.27 (95% CI 1.10–1.46) in 22,690 patients (73.6%) without history of cardiovascular disease.