What diagnosis can be used to justify aspirin (acetylsalicylic acid) 81 milligrams daily in a patient with diabetes, hypertension, hyperlipidemia, and obesity, but without a confirmed diagnosis of Cardiovascular Disease (CVD)?

From the Guidelines

For a patient with diabetes, hypertension, hyperlipidemia, and obesity without an official cardiovascular disease (CVD) diagnosis, you could use "Primary Prevention of Cardiovascular Disease" or "Atherosclerotic Cardiovascular Disease Risk Reduction" as the diagnosis to order aspirin 81 mg daily. This approach is based on the most recent and highest quality study, which recommends aspirin therapy for primary prevention in patients with diabetes who are at increased cardiovascular risk 1. The standard dosage is aspirin 81 mg once daily, taken with food to minimize gastrointestinal side effects. Before initiating therapy, assess bleeding risk and ensure there are no contraindications such as active peptic ulcer disease, recent bleeding events, or aspirin allergy. The rationale for low-dose aspirin in this case is that diabetes significantly increases cardiovascular risk, and when combined with other risk factors like hypertension, hyperlipidemia, and obesity, the cumulative risk may warrant antiplatelet therapy. However, the decision should be individualized based on the patient's calculated 10-year ASCVD risk score, with aspirin generally considered when the risk exceeds 10% and bleeding risk is low, as supported by the 2018 guidelines 1. Some key points to consider include:

• Aspirin therapy is recommended for primary prevention in patients with diabetes who are at increased cardiovascular risk 1
• The standard dosage is aspirin 81 mg once daily, taken with food to minimize gastrointestinal side effects
• Assess bleeding risk and ensure there are no contraindications before initiating therapy
• Individualize the decision based on the patient's calculated 10-year ASCVD risk score and bleeding risk
• Regular monitoring for bleeding complications and reassessment of risk-benefit ratio should be performed at follow-up visits, as recommended by the guidelines 1.

From the Research

Diagnosis for Aspirin Use in Diabetes Patients

The use of aspirin (acetylsalicylic acid) 81 milligrams daily in patients with diabetes, hypertension, hyperlipidemia, and obesity, but without a confirmed diagnosis of Cardiovascular Disease (CVD), can be justified under specific circumstances.

• Patients with diabetes are at an increased risk of cardiovascular disease compared to those without diabetes 2, 3, 4, 5.
• The decision to initiate aspirin for primary prevention of ASCVD must be considered carefully on an individual basis to balance the cardiovascular benefit and bleeding risk in all patients, especially those with diabetes 5.
• Current guidelines recommend aspirin use for primary prevention in people with and without diabetes under specific circumstances, such as those with a high baseline risk of ASCVD 2, 4, 6.
• Diabetic patients at higher risk (with 10-year ASCVD risk >10 %) are generally recommended for aspirin therapy if bleeding risk is felt to be low 4.

Guidelines for Aspirin Use

• The European Society of Cardiology (ESC), American College of Cardiology/American Heart Association (ACC/AHA), American Diabetes Association (ADA), Consensus Statement of Endocrinology, Cardiology, and Nephrology (ENCARNE), and the United States Preventive Services Task Force (USPTF) provide guidelines for aspirin use in primary prevention of ASCVD in diabetic patients 6.
• However, inappropriate aspirin use is common among diabetic patients, and guidelines that minimize differences in indications for aspirin use are needed for clinicians 6.

Risk Assessment

• A multifactorial approach that focuses on managing ASCVD risk factors such as hypertension, dyslipidemia, dysglycemia, and smoking is recommended in all patients 5.
• Novel markers such as coronary artery calcium scores and high-sensitivity C-reactive protein may help refine ASCVD risk prediction and guide utility for aspirin therapy 4.