Low-Dose Aspirin for Cardiovascular Disease Primary Prevention in Patients With Giant Cell Arteritis

Importance: Patients with giant cell arteritis (GCA) face an increased risk of major adverse cardiovascular events (MACE). The benefit of low-dose aspirin in these patients is unknown. Objective: To evaluate the 1-year association of low-dose aspirin with risk of MACE in primary prevention in patients with incident GCA and to evaluate the risk of major hemorrhage and net clinical benefit at predefined time points. Design, Setting, and Participants: This population-based cohort study used a target trial emulation framework with a cloning, censoring, and weighting approach within the French National Health Data System. Participants were individuals aged at least 50 years with incident GCA between 2010 and 2022, without previous cardiovascular events or antiplatelet or anticoagulant use at GCA diagnosis. Analysis was conducted from November 2024 to June 2025. Exposure: Initiation of low-dose aspirin vs not (control group) within 14 days of GCA diagnosis. Main Outcomes and Measures: The main outcome was MACE, a composite end point of ischemic stroke, myocardial infarction, and all-cause mortality. Major hemorrhages were evaluated as secondary outcomes. Results: A total of 14 528 individuals (median [IQR] age, 74 [67 to 80] years; 10 396 [72%] female), were included. Low-dose aspirin was initiated in 5220 individuals (36%). At 1 year, MACE risk was lower in the low-dose aspirin group (relative risk [RR], 0.86 [95% CI, 0.75 to 0.96]; risk difference [RD], -0.54% [95% CI, -0.99% to -0.12%]), while major hemorrhage risk was higher (RR, 1.29 [95% CI, 1.05 to 1.53]; RD, 0.51% [95% CI, 0.13% to 0.91%]). All-cause mortality was lower in the low-dose aspirin group at 1 year (RD, -0.43% [95% CI, -0.77% to -0.10%]). At 3 years, MACE events were less frequent in the low-dose aspirin group (RD, -1.08% [95% CI, -1.77% to -0.41%]), with no difference in major hemorrhages. A more pronounced association between low-dose aspirin and lower 1-year MACE was observed in women (RD, -0.78% [95% CI, -1.29% to -0.25%]) and patients with diabetes at GCA diagnosis (RD, -2.23% [95% CI, -3.48% to -1.02%]). Conclusions and Relevance: In this retrospective cohort study, low-dose aspirin at GCA diagnosis was associated with lower MACE at 1 and 3 years but higher hemorrhage risk at 1 year. Subgroup analyses suggested heterogeneity according to sex and diabetic status.