From the Guidelines
Aspirin therapy should not be routinely started in diabetes patients for primary prevention, except in those with high cardiovascular risk and low bleeding risk, typically those aged 40-70 with additional risk factors. The use of aspirin in diabetes patients for primary prevention is a complex issue, with recent studies suggesting that the net benefit is more controversial 1. The ASCEND trial, a large randomized controlled trial, found that aspirin reduced the risk of serious vascular events by 12%, but also increased the risk of major bleeding by 29% 1. The benefits of aspirin therapy in diabetes patients include reducing cardiovascular morbidity and mortality, particularly in those with high cardiovascular risk 1. However, the risks of bleeding, particularly gastrointestinal bleeding, must be carefully considered 1. Key factors to consider when deciding whether to start aspirin therapy in diabetes patients include:
- Age: aspirin may not be recommended for people over 70 years old due to the increased risk of bleeding 1
- Cardiovascular risk: aspirin may be considered in those with high cardiovascular risk, such as those with hypertension, smoking, dyslipidemia, family history of premature cardiovascular disease, or albuminuria 1
- Bleeding risk: aspirin may not be recommended in those with a high bleeding risk, such as those with a history of gastrointestinal bleeding or concurrent anticoagulant use 1 The recommended dose of aspirin for primary prevention is low-dose aspirin (75-100 mg daily) 1. Regular monitoring for bleeding complications is essential, and aspirin should be temporarily discontinued before surgical procedures 1. The decision to initiate aspirin therapy should be individualized based on a comprehensive risk-benefit assessment and patient preferences 1.
From the Research
Starting Aspirin in Diabetes Patients
- The use of low-dose aspirin for primary prevention of cardiovascular events in patients with diabetes is controversial due to the increased risk of bleeding 2, 3, 4.
- Studies have shown that low-dose aspirin does not reduce cardiovascular events in diabetic patients, but increases the risk of gastrointestinal bleeding 3, 4.
- A meta-analysis of randomized controlled trials found that low-dose aspirin reduced the risk of major adverse cardiovascular events (MACE) by 9% and increased the risk of major hemorrhage by 24% in diabetic patients 5.
- The benefits of low-dose aspirin were only observed in subjects aged 60 years or older, and the absolute benefits were largely counterbalanced by the bleeding hazard 5.
- Another study found that aspirin treatment was associated with a nonsignificant reduction in cardiovascular events in diabetic patients, and a nonsignificant increase in cardiovascular deaths 6.
- The American Diabetes Association, American Heart Association, and American College of Cardiology Foundation recommend aspirin for high-risk diabetic patients, but the evidence is not conclusive 4.
- The decision to start aspirin in diabetes patients should be highly individualized, based on a benefit-risk ratio assessment for the given patient 2.
- Factors such as age, glycemic control, kidney function, smoking status, hypertension, and dyslipidemia should be considered when making this decision 3, 4.