NEW research suggests that starting low-dose aspirin at diagnosis of giant cell arteritis (GCA) may reduce the risk of major cardiovascular events—but not without cost.
In a large population-based cohort study of over 14,000 patients, aspirin use was associated with a modest reduction in cardiovascular events and mortality, alongside an increased risk of major bleeding.
Lower Cardiovascular Risk Observed
Patients with GCA are known to face elevated cardiovascular risk, particularly in the early stages of the disease. In this study, 36% of patients initiated low-dose aspirin within two weeks of diagnosis.
At 1 year, those receiving aspirin had a lower risk of major adverse cardiovascular events (MACE), including stroke, myocardial infarction, and death. All-cause mortality was also reduced.
The benefit persisted at 3 years, with fewer cardiovascular events observed in the aspirin group.
Bleeding Risk Remains a Concern
However, the reduction in cardiovascular risk came with an important trade-off. At 1 year, patients taking aspirin had a significantly higher risk of major haemorrhage.
While this increased bleeding risk was not observed at 3 years, the early signal raises concerns about routine use, particularly in older patients who may already be vulnerable to bleeding complications.
Greater Benefit in Key Subgroups
The protective effect of aspirin was not uniform across all patients. It appeared more pronounced in women and in those with diabetes, suggesting that certain high-risk groups may derive greater benefit.
This variation highlights the importance of tailoring treatment decisions rather than applying a one-size-fits-all approach.
Balancing Benefit and Risk
The findings reinforce a familiar clinical dilemma: aspirin can reduce cardiovascular risk, but at the expense of increased bleeding.
In the context of GCA, where inflammation and vascular risk intersect, this balance becomes even more complex. The relatively small absolute risk reductions also suggest that the benefit, while real, may not justify universal use.
What This Means for Practice
This study does not settle the debate, but it does sharpen it. Low-dose aspirin may have a role in selected patients with GCA, particularly those at higher cardiovascular risk, but careful assessment of bleeding risk is essential.
For clinicians, the takeaway is clear: aspirin is not a default. It is a decision that requires weighing competing risks, patient by patient.
