Low-Dose Aspirin Shows Uncertain Risk-Benefit Profile in Giant Cell Arteritis: JAMA
France: The use of low-dose aspirin in patients with giant cell arteritis (GCA) remains controversial, as overall evidence does not clearly demonstrate a cardiovascular benefit. A retrospective study suggests that initiating aspirin for primary prevention may reduce the risk of major adverse cardiovascular events at 1 and 3 years.
However, this potential benefit is offset by an increased risk of major hemorrhage at 1 year, which appears to diminish over time and is not significant at 3 years. Overall, the balance between cardiovascular protection and bleeding risk with aspirin in GCA patients remains unclear and warrants careful individualized consideration.
These findings, published in JAMA Network Open, come from a large cohort study by Maxime Beydon and colleagues from Sorbonne Université, Paris. The study evaluated whether initiating low-dose aspirin at the time of GCA diagnosis in patients without prior cardiovascular disease affects cardiovascular and bleeding outcomes.
For this purpose, the researchers conducted a population-based analysis using data from the French National Health Data System. The study included 14,528 patients aged 50 years and older with newly diagnosed GCA between 2010 and 2022. Those with prior cardiovascular disease or on antiplatelet or anticoagulant therapy were excluded. The median age was 74 years, with most participants being women, and 36% started low-dose aspirin within two weeks of diagnosis.
The primary outcome was major adverse cardiovascular events (MACE), including ischemic stroke, myocardial infarction, and all-cause mortality, while major hemorrhagic events were assessed as secondary outcomes.
The study led to the following findings:
- At 1 year, low-dose aspirin use was associated with a modest reduction in major adverse cardiovascular events (MACE) compared to non-use.
- This reduction was accompanied by a decrease in all-cause mortality at 1 year.
- However, aspirin use was linked to a higher risk of major bleeding events during the same period.
- At 3 years, the reduction in cardiovascular events persisted in patients receiving low-dose aspirin.
- The increased risk of major hemorrhage observed at 1 year was no longer evident at 3 years.
- These findings indicate a possible shift in the risk-benefit balance of aspirin therapy over time.
- Subgroup analysis showed that the cardiovascular benefits of aspirin were more pronounced in women.
- Patients with diabetes at the time of GCA diagnosis also experienced greater cardiovascular protection during the first year of treatment.
Overall, the study highlights the complex trade-off between reducing cardiovascular risk and increasing bleeding risk when considering low-dose aspirin for primary prevention in GCA patients. While early benefits in reducing cardiovascular events are evident, the initial increase in hemorrhagic complications highlights the need for cautious patient selection.
The authors emphasize that treatment decisions should be individualized, taking into account patient-specific risk factors such as age, comorbidities, and bleeding risk. Further studies are needed to confirm these findings and better define the role of aspirin in patients with GCA and other chronic inflammatory conditions.
Reference:
Beydon M, Hajage D, Guédon AF, Carrat F, Seror R, Tubach F. Low-Dose Aspirin for Cardiovascular Disease Primary Prevention in Patients With Giant Cell Arteritis. JAMA Netw Open. 2026;9(4):e266579. doi:10.1001/jamanetworkopen.2026.6579
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