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People With Rheumatoid Arthritis Underuse Prophylactic Aspirin: Presented at ACR

By Paula Moyer

SAN DIEGO, CA -- November 21, 2005 -- People with rheumatoid arthritis (RA) are less likely to use low-dose aspirin for prevention of cardiovascular events than are people with other noninflammatory disorders, according to research presented here at the American College of Rheumatology Annual Scientific Meeting (ACR).

In addition, the researchers said, fewer than 20% of patients with RA in this study were using low-dose aspirin. The investigators speculated that, between the patients' specialty care and primary care, aspirin prophylaxis may be falling under the radar.

"Rheumatologists --- may be assuming preventive issues are being addressed by the primary physician, whereas primary physicians may not be aware that those with rheumatoid arthritis are under additional cardiac risk that may warrant aspirin use," said principal investigator Lee Colglazier, MD, practicing rheumatologist, Compass Health Care, Crestview Hills, Kentucky, at a briefing on November 16^th.

"Whatever the cause, rheumatologists should make sure that their patients are receiving the recommended care for the prevention and treatment of cardiovascular disorders," said Dr. Colglazier, who was a rheumatology fellow at Wake Forest University School of Medicine in Winston-Salem, North Carolina, when he conducted the study.

Guidelines from the United States Preventive Services Task Force of the Department of Health and Human Services recommend that adults take low-dose aspirin daily (81 to 325 mg/day) if they have a high 10-year risk of myocardial infarction.

According to previous research, inflammatory diseases are a known risk factor for cardiovascular disease.

The investigators conducted their study to determine the extent to which patients with RA were getting the recommended prophylactic care.

For the 3-year period ending in 2004, the investigators surveyed 18,123 patients every 6 months as part of a study of rheumatic disease outcomes. Among these patients, 14,114 had RA and 4,009 had noninflammatory rheumatic disorders.

When the investigators adjusted the results for age and sex, subjects with RA had an odds ratio (OR) of 1.7 for myocardial infarction.

The results also show that patients with RA were less likely to be taking prophylactic aspirin than were subjects with other rheumatic disorders (OR 0.67). Among those with RA, 8.14% were taking low-dose aspirin compared with 25.1% of those with other rheumatoid disorders.

Even after the investigators adjusted for age and sex and added the covariate of myocardial infarction history, the OR for taking aspirin remained the same, the investigators reported. Aspirin prophylaxis was always lower in patients with RA, Dr. Colglazier reported.

Within the group with RA, men had an OR of 1.6 for aspirin use. Subjects using cyclooxygenase 2 inhibitors (COX-2 inhibitors) were as likely to use aspirin, with an OR of 1.06, and whites and those with higher education were more likely to use aspirin.

Factors associated with less aspirin use were use of nonspecific nonsteroidal anti-inflammatory drugs (NSAIDs, OR of 0.89); worse functional status (OR of 0.92); increased pain (OR of 0.98); fibromyalgia (OR of 0.91); and prednisone use (OR of 0.94).

The best predictive model of prophylactic aspirin use in RA consisted of NSAID use, majority ethnicity, functional status, age, sex, myocardial infarction history, and history of hypertension. However, even these variables taken together had poor predictability for prophylactic aspirin use, the investigators reported.


[Presentation title: Rheumatoid Arthritis (RA) Patients are Less Likely to be Treated With Prophylactic Aspirin Despite an Increased Risk of Myocardial Infarction. Abstract 1904]

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