Aspirin: The Need for Wider Utilization in the Treatment and Prevention of CVD in RA

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Management

" Aspirin: The Need for Wider Utilization in the

Treatment and Prevention of Cardiovascular

Disease in Patients With Rheumatoid Arthritis "

H. Hennekens, MD, DrPH, FACC, FACPM

Professor of Medicine & Epidemiology and Public Health

University of Miami School of Medicine

Director of Research

Agatston Research Institute (ARI)

" CONCLUSIONS

The increasing global burden of CVD, which includes sustained

high rates in developed countries and rapidly increasing rates in

developing countries, underscores the need for more widespread

and appropriate utilization of therapies of proven benefit such as

aspirin in the secondary prevention of occlusive CVD, during

acute evolving MI and occlusive stroke, and in primary prevention

of a first MI.

These RA patients with CVD have 10-year risks ?20%, and a large

proportion without CVD have 10-year risks ?10%. All such RA

patients should receive aspirin in the treatment and prevention

of CVD and may also require NSAIDs or COX-2 inhibitors, all of

which increase GI side effects. This therapeutic paradigm raises

the question of whether RA patients would also benefit from

concomitant drug therapy to decrease GI side effects.

The more widespread and appropriate use of aspirin, especially in

patients with RA, will avoid many premature deaths in the

secondary prevention of CVD and many MIs in primary

prevention. In the secondary and primary prevention of CVD,

drugs of proven benefit include aspirin, statins, angiotensinconverting

enzyme inhibitors, and beta-adrenergic blockers.

Of these, aspirin is by far the least expensive, and it is available

over the counter. Nonetheless, aspirin still remains underutilized

in the secondary prevention of CVD and primary prevention of MI.

It may well be true that if aspirin were half as effective, 10 times

more expensive, and prescribed rather than over the counter, it

would be taken more seriously. With respect to the role of aspirin

in secondary prevention of CVD and primary prevention of MI,

there are enormous clinical and public health challenges that are

even greater among patients with RA. "

http://www.jointandbone.org/satelliteprogram/whitepaperseries/01may04/pdf/WhiteP\

aper_Hennekens_v9.pdf

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