Long used by non-diabetic patients as part of preventative therapy for cardiovascular disease, the use of aspirin and diabetes preventative therapies is newer. A scientific statement from 2010 said that low-dose aspirin is “reasonable” for people with no history of vascular disease by with a high 10-year risk of cardiovascular complications. The statement, released by the American Diabetes Association (ADA), American Heart Association (AHA), and American College of Cardiology (ACC) called for stricter criteria in the use of aspirin therapy for diabetics. The new aspirin/diabetes guidelines restrict the once general recommendation of aspirin for diabetics over the age of 40.
Diabetes Aspirin Guidelines
The potential risks of side effects of aspirin therapy have been weighed against the benefits leading to the decision that low-dose aspirin (75-162 mg/d) is now only recommended for diabetic adults with no history of cardiovascular disease but who are at increased risk of cardiovascular events. Risk should be based on age and an additional risk factor such as smoking, dyslipidemia, hypertension, albuminuria, or a family history. Aspirin is not recommended for high-risk diabetes patients who have a risk of bleeding, nor is it recommended for people who are at low risk of cardiovascular disease. The decision to change the guidelines came after an examination of meta data from several studies. Two significant studies that were considered were examining prevention of arterial disease with aspirin in diabetes patients. Both studies found a “nonsignificant” reduction of the likelihood of heart disease when diabetic patients took aspirin.
Diabetes Aspirin Therapy
Researchers have found that there is an excess of thromboxane (vasoconstrictor and platelet aggregant) released in type 2 diabetic patients with cardiovascular disease. Aspirin blocks thromboxane synthesis and has historically been used as a preventive measure for non-diabetic individuals. Analysis of 145 trials of antiplatelet therapy after myocardial infarction, stroke, or ischemia attack found a reduction of vascular events in about one quarter of each category that were comparable to non-diabetic individuals. A U.S. Physicians’ Health Study conducted a prevention trial administering 325 mg every other day, controlled by a placebo, to males resulting in a 44% risk reduction in the group receiving aspirin.
The necessity of diabetes aspirin therapy should be determined on a patient-by-patient basis. The ADA, AHA, and ACC recommend using the UKPDS Risk Engine (http://www.dtu.ox.ac.uk/riskengine/) and ARIC Coronary Heart Disease Risk Calculator (http://aricnews.net/riskcalc/html/RC1.html) among other tools to assess risk in patients. A major risk of diabetes aspirin therapy is gastric mucosal injury and gastrointestinal hemorrhage, which can be caused by even low dosages. Additional it is not suitable for people under the age of 21 due to risk of Reye’s syndrome.
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