Aspirin Therapy For Diabetics With Heart Disease

by moveforward on June 1, 2010

According to a joint statement from the American College of Cardiology Foundation, the American Diabetes Association and the American Heart Association, in order to prevent the occurrence of a first heart attack, people with diabetes who are at risk of heart disease could make use of a low-dose aspirin therapy as one of the preventive measures.

The statement said that, taking low-dose aspirin to prevent heart disease is reasonable for adults with diabetes, who are at increased risk of cardiovascular disease and not at risk for bleeding.

Low-dose aspirin therapy is recommended for most men over age 50 and women more than 60 with diabetes who have one or more additional heart disease risk factors, the joint statement added.

It also stated that, aspirin should not be recommended for heart disease prevention for men less than 50 and women less than 60 with diabetes with any major additional heart risk factors, because the potential adverse effects from gastrointestinal bleeding offset the potential benefits of treatment.

Most men over age 50 and most women over age 60 who have additional risk factors are the type of patients with diabetes eligible for low-dose aspirin therapy based on the guidelines.

The trials suggest that aspirin modestly reduces risk of cardiovascular events despite mixed results, but more research is needed to further define the specific effects of the medicine, according to the statement.

Michael Pignone, M.D., the lead author of the statement and Chief of the General Medicine Division and Professor of Medicine at the University of North Carolina in Chapel Hill said, “Because the relative risk reduction appears to be modest, the panel felt that we are on strongest ground recommending aspirin for those at increased cardiovascular disease (CVD) risk, defined by the age categories and risk factors mentioned or by a calculation of CVD risk.”

“We felt that the benefits were likely to exceed the downsides, such as gastrointestinal bleeding, for the groups mentioned. There will be some younger people with sufficient risk to warrant aspirin, but many who are not at sufficient risk.”

The scientific evidence supporting aspirin therapy depends on the underlying CVD risk according to the authors of the statement.

They said that the use of aspirin therapy depends on the use of other treatments, such as cholesterol-lowering medicines and blood pressure control, aside from the avoidance of smoking cigarettes.

In 2007, the American Diabetes Association and AHA jointly recommended that aspirin therapy (75–162 mg/day) be started for both men and women above age 40 with another major risk factor, such as a family history of CVD, high blood pressure, smoking, high cholesterol or protein in the urine.

Craig Williams, Ph D., a co-author of the statement and Associate Professor of Pharmacy and Medicine at Oregon Health Sciences University in Portland, Oregon clarified that, “The new recommendations only address primary prevention.”

“All three organizations continue to strongly recommend low-dose aspirin for all patients who have previously had a heart attack or stroke, so-called secondary prevention, “he added.

Meanwhile, according to the authors, the major adverse effects of aspirin therapy include intra-cranial bleeding leading to hemorrhagic stroke and gastrointestinal bleeding.

Based on data from primary and secondary prevention trials conducted on patients with and without diabetes, low-dose aspirin appears to be associated with an absolute risk of hemorrhagic strokes of one per 10,000 people annually, the statement added.

The coauthors are: Mark J. Alberts, M.D.; John A. Colwell, M.D., Ph.D.; Mary Cushman, M.D., M.Sc.; Silvio E. Inzucchi, M.D.; Debabrata Mukherjee, M.D.; Robert S. Rosenson, M.D.; Peter W. Wilson, M.D.; and M. Sue Kirkman, M.D.

Aspirin Therapy For Diabetics With Heart Disease

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