RA patients don’t use routine low-dose aspirin, despite high CV risk

Rheumatoid arthritis (RA) patients are less likely to take daily preventive doses of aspirin to reduce cardiovascular (CV) risks, despite the increased risk of heart attack associated with RA, according to survey data presented at the 2005 ACR/ARHP Annual Scientific Meeting.

“Rheumatologists might be assuming that aspirin prescriptions will be dealt with by the primary-care physician who will initiate the prophylactic regimen. We need better communication between rheumatologists and primary-care physicians so that cardiovascular protection for RA patients does not fall through the cracks,” said lead author Dr Chris Colglazier (now in private practice in Crestview Hills, KY).RA patients one third less likely to use aspirinThe US Preventive Services Task Force recommends routine low-dose aspirin (81 mg-325 mg/day) for adults who are at increased risk of having a heart attack over the next 10 years. RA is associated with such a CV risk. Colglazier et al surveyed 14 114 RA patients semiannually for three years as part of an arthritis-outcomes study. Results in those patients were compared with outcomes in 4009 patients with noninflammatory rheumatic disorders. Colglazier found that, adjusted for age and sex, RA patients had an expected greater risk of myocardial infarction (MI) compared with noninflammatory disorders (odds ratio [OR] 1.7.)This probably reflects in part the fact that RA patients were much less likely to take low-dose aspirin (OR 0.67), and this did not change when history of MI was added as a covariate. The age- and sex-adjusted rates of low-dose aspirin use were 18.4% for RA patients and 25.1% for patients with noninflammatory rheumatic diseases. “Rheumatologists should be aware that RA patients . . . receive less than the recommended care for prophylaxis and treatment of CV disorders.” Among RA patients, men were more likely to use low-dose aspirin (OR 1.6). COX-2-inhibitor use was associated with greater use of low-dose aspirin (OR 1.06), as was white ethnicity (OR 1.20). Patients who used nonspecific NSAIDs were less likely to use low-dose aspirin (OR 0.89), as were patients with poorer functional status, increased pain, or use of prednisone. “Although the rate of MI is increased in RA, use of low-dose aspirin by RA patients is reduced compared with non-RA patients. We were unable to find any clinical, demographic, or treatment variables that explained this rate difference. Several possibilities are suggested. Physicians may feel that the complicated RA treatments weigh against additional therapies. In addition, package inserts and pharmacists recommend against using aspirin with methotrexate or NSAIDs. Finally, rheumatologists, as subspecialists, may not address primary-prevention issues. Although further studies are needed to understand this discrepancy, rheumatologists should be aware that RA patients, on average, receive less than the recommended care for prophylaxis and treatment of CV disorders,” Colglazier said. (Source: Colglazier L, Wolfe F, Michaud K, et al. Rheumatoid arthritis (RA) patients are less likely to be treated with prophylactic aspirin despite an increased risk of myocardial infarction. 2005 ACR/ARHP Annual Scientific Meeting; Nov. 12-17, 2005; San Diego, CA. Abstract 1904. Joint & Bone: Rheumawire: Janis Kelly: December 2005.)