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Low-dose aspirin as primary prophylaxis for cardiovascular events in systemic lupus erythematosus: a long-term
Michele Iudici1, Serena Fasano1, Luisa Gabriele Falcone1
1Department of Clinical and Experimental Medicine, Second University of Naples Rheumatology Section, Naples, Italy.
Insights
Low-dose aspirin (ASA) may reduce cardiovascular events in systemic lupus erythematosus (SLE) patients. This study found ASA was safe and associated with fewer cardiovascular events in SLE patients compared to those not taking it.
Area of Science:
- Rheumatology
- Cardiology
- Clinical Pharmacology
Background:
- Systemic lupus erythematosus (SLE) patients face higher cardiovascular (CV) morbidity and mortality than the general population.
- Aspirin (ASA) is known to reduce CV events in high-risk general populations, but its primary prophylactic efficacy in SLE remains uninvestigated.
Purpose of the Study:
- To investigate the efficacy of low-dose aspirin (ASA) as a primary prophylaxis for cardiovascular (CV) events in patients with systemic lupus erythematosus (SLE).
Main Methods:
- Retrospective review of clinical charts for SLE patients meeting 1992 ACR or 2012 SLICC criteria without prior CV events.
- All patients received ASA at first visit; adherence and discontinuation reasons were recorded.
- Follow-up recorded CV event occurrence, with analysis comparing ASA-treated and non-ASA-treated groups.
Main Results:
- 167 SLE patients were followed for a median of 8 years. Five CV events occurred in 146 ASA-treated patients (4.2/1000 person-years) versus four in 21 non-ASA-treated patients (30/1000 person-years; P = 0.0007).
- The CV event-free rate was significantly higher in the ASA-treated group (log-rank test χ(2) = 15.74; P = 0.0001).
- No significant ASA-related side effects were reported.
Conclusions:
- Low-dose aspirin (ASA) appears to be a safe treatment for systemic lupus erythematosus (SLE) patients.
- ASA may offer benefits in the primary prevention of cardiovascular events in this high-risk population.
- Further controlled, prospective studies are warranted to define ASA's definitive role in SLE patients.
Objectives:
Cardiovascular (CV) morbidity and mortality are significantly greater in SLE patients than in the general population. ASA is known to be associated with a decrease in the incidence of CV events in high-risk patients from the general population, but its efficacy as primary prophylaxis in SLE patients has not yet been investigated.
Methods:
The clinical charts of SLE patients consecutively admitted to a tertiary centre who, at admission, satisfied 1992 ACR and/or 2012 SLICC classification criteria for SLE and had not experienced any CV event, were reviewed. The occurrence of any CV event was recorded at each visit. ASA was prescribed to all patients at first visit. The rate and reasons for ASA discontinuation were also recorded at each visit.
Results:
One hundred and sixty-seven consecutive SLE patients were enrolled and followed up for a median of 8 years (range 1-14 years). Among them, 146 regularly took the medication (ASA-treated patients) and 21 refused to take or discontinued it (non-ASA-treated patients). Five CV events occurred in the 146 ASA-treated patients (4.2 per 1000 person-years) and four in the 21 non-ASA-treated patients (30 per 1000 person-years; P = 0.0007). The CV event-free rate was higher in ASA-treated than in non-ASA-treated patients (log-rank test χ(2) = 15.74; P = 0.0001). No relevant side-effect related to ASA was recorded.
Conclusion:
Low-dose ASA is a safe treatment and may be beneficial in the primary prophylaxis of CV events in SLE patients. Controlled, prospective studies are needed to provide a better definition of its role in these patients.
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