Low-dose aspirin may be considered for the primary prevention of cardiovascular disease (CVD) in patients with systemic rheumatic diseases, especially for those with additional CV risk factors, according to a review published in Rheumatology.1
Aspirin is frequently used for the secondary prevention of CVD; however, limited data support the role of aspirin for primary prevention. Because patients with autoimmune systemic rheumatic diseases vs the general population may be at increased risk for CV events, aspirin use for primary prevention of CVD may be considered for these patients.
The objective of the current review was to report the current available evidence on the effectiveness of aspirin for the primary prevention of CVD in patients with systemic autoimmune rheumatic diseases.
Cardiovascular complications are the leading cause of death in patients with lupus, and while traditional CV risk factors are more common in lupus, they alone do not fully explain the increased atherosclerosis risk in these patients. Despite limited available data on the role of aspirin for the primary prevention of CVD in lupus, the 2019 update of the European League Against Rheumatism (EULAR) recommendations for lupus management supported the consideration of low-dose aspirin based on individual CV risk profile. A combination of antimalarials plus aspirin was reported to be associated with a further reduction in the CV risk of patients with lupus.
Compared with the general population, patients with rheumatoid arthritis (RA) are at increased risk for CVD. In addition to traditional risk factors for CVD, which are elevated among patients with RA, chronic inflammation may also contribute to the excess CV burden. Few studies have explored the role of aspirin for the primary prevention of CVD in these patients, with conflicting results.
Systemic sclerosis (SSc) has also been associated with a higher prevalence of CVD. A European study reported that cardiovascular causes were responsible for 29% of deaths in patients with SSc.2 Aspirin use was found to be associated with a lower incidence of cardiac blocks and/or Q waved and/or pacemaker implantation. However, additional studies to assess the role of aspirin for the primary prevention of CVD in patients with SSc reported conflicting results.
The role of aspirin for the primary prevention of CVD for patients with other systemic autoimmune disease remains unclear. Aspirin can be considered for primary prevention of thrombosis in asymptomatic patients with antiphospholipid positivity, particularly in the presence of additional risk factors.
Limitations of this review included the lack of assessment of disease severity, the inclusion of patients with a history of CV events, and CVD analysis associated with myocardial infarction.
“High-quality randomized controlled trials performed in subgroups of patients with specific rheumatic diseases are needed to develop evidence-based guidelines,” the study authors concluded.
1. Fasano S, Iacono D, Riccardi A, Ciccia F, Valentini G. The role of aspirin in the primary prevention of accelerated atherosclerosis in systemic autoimmune rheumatic diseases. Published online August 24, 2020. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa335
2. Tyndall AJ, Bannert B, Vonk M, et al. Causes and risk factors for death in systemic sclerosis: a study from the EULAR Scleroderma Trials and Research (EUSTAR) database. Ann Rheum Dis. 2010;69:1809-1815.