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

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



Dec 1, 2005



Janis





San Diego, CA - 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 [1].

" 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 Colglazier (now in private practice in Crestview

Hills, KY).

RA patients one third less likely to use aspirin







The 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.

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.