Low-Dose Aspirin at GCA Diagnosis May Reduce Cardiovascular Events, But Raise Bleeding Risk

The initiation of low-dose aspirin in patients with newly diagnosed giant cell arteritis (GCA) is found to be associated with a reduced risk of major adverse cardiovascular events (MACE), including heart attack, stroke, and death within the first year, according to emerging data published in JAMA Network Open. However, this benefit is also associated with an increased risk of major hemorrhage. This data demonstrates a complex risk-benefit profile for aspirin use in this high-risk population.¹

GCA and Aspirin Use

GCA is a severe inflammatory condition and a large-vessel vasculitis that particularly targets adults aged over 50. GCA is associated with a heightened risk of cardiovascular disease (CVD), particularly in the early months following diagnosis. The increased risk is speculated to be a result of systemic inflammation and corticosteroid therapy that requires high dosage, both of which accelerate vascular damage over time.^1-3

Previously, low-dose aspirin had been considered as a potential means of treatment for cardiovascular risk reduction in GCA, although evidence supporting routine use has been inconsistent. The European League Against Rheumatism (EULAR) 2018 update advises against routine antiplatelet therapy in all patients with large-vessel vasculitis and instead encourages a more individualized approach.⁴

Research has been conducted on participants without GCA in order to evaluate whether aspirin could be considered as a means for primary prevention in cardiovascular events. Large randomized trials in these populations—including ASPREE (NCT01038583), ARRIVE, and ASCEND—have revealed inconsistent cardiovascular benefit with a consistent increase in major bleeding risk, particularly among older adults and higher-risk groups. These findings have led to a more conservative, patient-specific approach to aspirin use in primary prevention, with greater emphasis on balancing cardiovascular benefit against bleeding risk.^5-7

Study Design

A population-based study utilizing the French National Health Data System, which included 14,528 patients aged a minimum of 50 years, was diagnosed with GCA and had no previous history of any cardiovascular disease. The patients in the research were categorized based on whether they initiated low-dose aspirin within 14 days of receiving GCA diagnosis or did not.¹

The data revealed a lower risk of MACE at 1 year of patients initiating low-dose aspirin in comparison with nonusers. Secondary outcomes included major hemorrhagic events and longer-term cardiovascular outcomes up to 3 years. To reduce confounding and better approximate a randomized clinical trial, researchers used a target trial emulation approach with advanced statistical methods to balance baseline differences between treatment groups.¹

Key Findings

The data revealed that at 1 year, low-dose aspirin use was associated with a lower risk of MACE in comparison with non-aspirin use (relative risk, 0.86; risk difference, −0.54%). All-cause mortality was also reduced in the aspirin group, although it was found that aspirin use was linked with an increased risk of major hemorrhage at 1 year.¹

At 3 years, the reduction of MACE carried on with no significant difference in major hemorrhage risk. Subgroup analyses demonstrated greater benefit among women and patients with diabetes, suggesting variability in treatment effect across patient populations.¹

Clinical Applications

This data assists in further understanding how essential individualized risk-benefit assessment is when taking into consideration low-dose aspirin in patients diagnosed with GCA. Pharmacists play an essential role in evaluating cardiovascular risk and bleeding risk, especially in older patients and those receiving corticosteroid therapy.^2,3

With the increased risk of hemorrhage observed, it is crucial to keep the patient informed on signs and symptoms of bleeding and available options to mitigate gastrointestinal risk when appropriate.^5-7

REFERENCES

1. 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

2. Buttgereit F, Matteson EL, Dejaco C. Polymyalgia rheumatica and giant cell arteritis. JAMA. 2020;324(10):993–994. doi:10.1001/jama.2020.10155

3.Tomasson G, Peloquin C, Mohammad A, et al. Risk for cardiovascular disease early and late after a diagnosis of giant-cell arteritis: a cohort study. Ann Intern Med. 2014;160(2):73-80. doi:10.7326/M12-3046

4. Hellmich B, Agueda A, Monti S, et al. 2018 Update of the EULAR recommendations for the management of large vessel vasculitis. Annals of the Rheumatic Diseases. 2020;79:19-30. doi:10.1136/annrheumdis-2019-215672

5. McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability-free survival in the healthy elderly. N Engl J Med. 2018;379(16):1499-1508. doi:10.1056/NEJMoa1805819

6. Gaziano J, Brotons C, Coppolecchia R et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. The Lancet. 2018;392(10152):1036-1046. doi:10.1016/S0140-6736(18)31924-X

7. The ASCEND Study Collaborative Group. Effects of aspirin for primary prevention in persons with diabetes mellitus. N Engl J Med. 2018;379(16):1529-1539. doi:10.1056/nejmoa1804988

‌