INFO - The role of aspirin in RA

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The Role of Aspirin in Rheumatoid Arthritis Treatment

By Petya Stoeva

Thursday, 16 February 2006

Low-dose daily aspirin intake is a traditional prevention against

cardiovascular disease, but new research shows that people with rheumatoid

arthritis (RA), who are more likely to have heart attacks and strokes than

the general population, often fail to take the recommended dosage of aspirin

to prevent those events.

Researchers from Wake Forest University School of Medicine in

Winston-Salem, N.C., and the National Data Bank for Rheumatic Diseases in

Wichita, Kan., studied 14,000 people with RA and 4,000 with non-inflammatory

rheumatic diseases for three years. They found that respondents with RA had

a twice higher risk of heart attack than those with non-inflammatory

rheumatic conditions. Despite that elevated risk, aspirin intake among

people with RA was roughly half of that among the comparison group, even

among people with RA who had heart attacks in the past. In the RA group, men

were more likely to use aspirin than women.

The researchers were unable to find any explanation for those

differences. The lead author, Dr. Lee Colglazier, a rheumatologist in

Crestview Hills, Ky., and a fellow in rheumatology at Wake Forest University

during the study, suggested that one reason for the low intake of aspirin

may be that RA treatment is already complicated and rheumatologists hesitate

to add yet another drug to the list.

Package information in RA medications, such as methotrexate and

prednisone, cautions against using aspirin with the prescribed regimen and

this may also discourage people from taking aspirin, Colglazier says, adding

that most physicians find the practice safe. Yet, the biggest reason for the

low use of aspirin among people with RA may be that rheumatologists don't

get involved.

" When I ask other rheumatologists [about aspirin] they say it's not

their issue, it's a primary prevention issue, " Colglazier says.

" Rheumatologists need to be more proactive. "

In his own practice, Colglazier says he screens all his patients by

examining their risk factors for heart disease and asking if they take

aspirin.

" I still prefer the primary care doctor to prescribe the aspirin but I

make sure it's addressed, " he says. " I write a note to the primary care

doctor or tell the patient to ask the doctor. "

Aspirin has long been the norm for preventing cardiovascular disease,

but recent research shows that it protects men and women differently. In

2005, a major 10-year government-sponsored placebo-controlled study of

40,000 healthy women showed that aspirin does not protect healthy women

under 65 from their first heart attack or from death from cardiovascular

causes. It does, however, reduce by 17 percent the risk of stroke compared

with the placebo group. For women 65 and older, however, aspirin was found

to reduce both the risk of heart attack and ischemic stroke by one-third.

Another recent study analyzed all published prospective randomized

controlled trials of aspirin and concluded that women's risk of heart

attacks was not affected by aspirin but men's risk was reduced by a third.

Aspirin did, however, reduce the risk of stroke in women by 17 percent and

didn't change the odds for stroke in men. Aspirin didn't affect the rates of

cardiovascular death in either men or women.

Although research has shaken the belief in the preventive abilities of

aspirin, it is still the norm for guarding against cardiovascular problems

among women.

" Aspirin does decrease the risk of stroke and half of all

cardiovascular events in women are strokes, " says Dr. Blumenthal,

director of the s Hopkins Ciccarone Preventive Cardiology Center, who

wasn't involved with the studies. " We clearly should give it to women with

heart disease and diabetes and for younger women who have two risk factors

for heart disease. "

Women with RA over the age of 45 should also take aspirin because the

RA places them at risk for coronary heart disease, Blumenthal says. Better

dietary habits and increased exercise are also part of cardiovascular

prevention and should be emphasized, he reminds.

Colglazier says aspirin is still useful for prevention of heart

disease in women, but it's being ignored for people with RA who are at

higher risk.

" We're all missing the opportunity, " he says.

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Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org