Aspirin Use in Rheumatoid Arthritis Patients with Increased Risk of Cardiovascular Disease

Objectives. To examine the patterns of low-dose aspirin use in rheumatoid arthritis (RA) patients with high risk for coronary artery disease (CAD). Methods. Cross-sectional study of 36 consecutive RA patients with a Framingham score ≥10% for CAD. Eligible RA patients were provided with a questionnaire on CAD risk factors and use of low-dose aspirin. For aspirin nonusers, the reason for nonuse was requested by both the patient and rheumatologist. Questions for patients included physician's advice, self-preference, history of gastrointestinal bleeding, allergy to aspirin, or concomitant use of other anti-inflammatory medications. Questions for rheumatologists included awareness of the increased CAD risk, attribution, patient preference, history of gastrointestinal bleeding, allergy to aspirin, and medication interactions. Results. Patients participated in the study; 8 patients reported using daily aspirin, while 23 patients did not. The main reason cited by patients for not taking aspirin was that they were not instructed by their primary care physician (PCP) to do so ( ), which was also the main reason cited by rheumatologists ( ). Conclusion. This study confirmed underutilization of aspirin in RA patients at high risk for CAD, largely due to the perception that this is an issue which should be handled by the PCP. 1. Introduction Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease with leading cause of mortality being coronary artery disease (CAD), accounting for nearly 40–50% of deaths [1–4]. This increased burden of CAD, particularly myocardial infarction (MI), in RA is independent of traditional CAD risk factors, and it is attributed in part to chronic systemic inflammation [5, 6]. Low-dose aspirin has been shown to be beneficial for primary and secondary prevention of coronary artery disease (CAD) in numerous studies [7–10] in the general population, but this has not been studied in RA patients. One of the most commonly used tools to calculate CAD risk in the general population is the Framingham risk score, a compilation of traditional CAD risk factors that estimates the 10-year risk of CAD risk, with risk ≥10% being the threshold for recommendation for low dose aspirin use for CAD prevention [11]. The Framingham score does not take into account RA as a risk factor for CAD, but Chung et al. showed that a higher Framingham score is independently associated with coronary artery calcification as determined by high electron beam computed tomography in RA patients [12]. To account for the increased CAD risk conferred by RA, the European