From the Guidelines
Aspirin therapy (75-162 mg/day) is recommended for DM2 patients with established cardiovascular disease (CVD) or those at increased cardiovascular risk (10-year risk >10%) who are not at increased bleeding risk, as stated in the 2019 ESC guidelines 1.
Patient Selection for Aspirin Therapy
The selection of patients for aspirin therapy should be based on their cardiovascular risk profile.
- Patients with established CVD are recommended to take aspirin as a secondary prevention strategy.
- For primary prevention, aspirin should be considered in adults with additional risk factors, such as family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria.
ACE Inhibitors or ARBs
ACE inhibitors or ARBs are indicated in patients with DM and CAD to reduce the risk of CV events, as recommended by the 2019 ESC guidelines 1.
- These medications are particularly recommended for diabetes patients with hypertension, kidney disease, or cardiovascular disease.
- They help protect kidney function and reduce cardiovascular events.
Statin Therapy
Statin therapy is recommended in patients with DM and CAD to reduce the risk of CV events, as stated in the 2019 ESC guidelines 1.
- Statins are recommended for all diabetic patients with established CVD regardless of age.
- For primary prevention, statins are recommended in those aged 40-75 with additional risk factors.
- High-intensity statins (like atorvastatin 40-80 mg or rosuvastatin 20-40 mg) are preferred for patients with CVD, while moderate-intensity statins may be appropriate for primary prevention. These recommendations aim to reduce the significantly elevated cardiovascular risk that accompanies diabetes through targeted interventions addressing multiple pathways of vascular damage, as supported by the ADA guidelines 1.
From the Research
Aspirin Therapy
- The American Diabetes Association (ADA) recommends the use of aspirin for all patients with Type 2 Diabetes Mellitus (DM2) older than 40 years of age, in the absence of contraindications 2.
- Aspirin therapy is underutilized among patients with DM2, with only 27.5% of patients older than 40 years of age using aspirin, despite the ADA guidelines 2.
- The ADA previously recommended aspirin prophylaxis for all diabetic patients over the age of 30 with one additional risk factor for cardiovascular disease (CVD) 3.
- However, recent studies have shown that the use of aspirin in primary prevention of cardiovascular events in diabetic patients is still debated, and its benefits may vary depending on the patient's risk factors 4, 5.
Angiotensin-Converting Enzyme (ACE) Inhibitors/Angiotensin Receptor Blockers (ARBs)
- ACE inhibitors and ARBs have been shown to reduce the incidence of new-onset type 2 diabetes by 25% in a pooled analysis of 12 randomized controlled clinical trials 6.
- The use of an ACE inhibitor or ARB should be considered in patients with pre-diabetic conditions such as metabolic syndrome, hypertension, impaired fasting glucose, family history of diabetes, obesity, congestive heart failure, or coronary heart disease 6.
Statins
- There is no direct evidence in the provided studies regarding the use of statins in patients with Type 2 Diabetes Mellitus (DM2) according to the American Diabetes Association (ADA) guidelines.
Patient Selection
- Patients with DM2 who should take aspirin, ACE inhibitors/ARBs, and statins according to the ADA guidelines are those who are at high risk of cardiovascular events, such as older patients with additional cardiovascular risk factors 2, 3, 5.
- However, the use of these medications should be individualized based on the patient's specific risk factors and medical history, and in accordance with the latest clinical guidelines 4, 6.