Is aspirin (ASA) recommended for a 59-year-old female with diabetes mellitus (DM) type 2 and hypertension (HTN)?

From the Guidelines

Aspirin (ASA) may be considered for primary prevention in a 59-year-old female with type 2 diabetes and hypertension, but only after a comprehensive discussion on the benefits versus the comparable increased risk of bleeding, as per the latest guidelines from 2024 1. When considering aspirin for primary prevention, it's essential to assess the individual's cardiovascular risk using validated risk calculators, such as the ASCVD risk score, and weigh this against bleeding risks.

• The patient's 10-year ASCVD risk score should be calculated, taking into account additional factors like cholesterol levels, smoking status, family history, and evidence of end-organ damage.
• If her 10-year ASCVD risk score is high (generally >10%), low-dose aspirin (75-162 mg/day) might be considered, as suggested by the 2024 guidelines 1.
• However, the focus of treatment should primarily be on optimizing blood pressure control, diabetes management, statin therapy if indicated, and lifestyle modifications including diet, exercise, and smoking cessation, as these interventions provide more substantial cardiovascular benefit with less risk than aspirin in primary prevention settings.
• Non-invasive imaging techniques, such as coronary calcium scoring, may help further tailor aspirin therapy, particularly in those at low risk, as mentioned in the 2024 guidelines 1.
• Ultimately, the decision to use aspirin for primary prevention should be made in the context of shared decision-making, carefully weighing the cardiovascular benefits with the fairly comparable increase in risk of bleeding, as recommended by the 2022 and 2024 guidelines 1.

From the Research

Aspirin Therapy for Primary Prevention in Patients with Type 2 Diabetes Mellitus

• The use of aspirin for primary prevention of cardiovascular events in patients with type 2 diabetes mellitus is a topic of ongoing debate 2, 3, 4.
• A study published in The New England Journal of Medicine in 2018 found that aspirin use prevented serious vascular events in persons with diabetes and no evident cardiovascular disease, but it also caused major bleeding events 2.
• Another study published in Circulation in 2017 found that low-dose aspirin did not reduce cardiovascular events in patients with type 2 diabetes mellitus, but increased the risk of gastrointestinal bleeding 3.
• A meta-analysis published in Diabetes Research and Clinical Practice in 2010 found that aspirin therapy was not associated with a statistically significant reduction in major cardiovascular events in patients with diabetes 4.

Considerations for Aspirin Therapy in Patients with Type 2 Diabetes Mellitus and Hypertension

• Patients with type 2 diabetes mellitus and hypertension are at increased risk of cardiovascular events, and the use of aspirin may be considered as part of a comprehensive prevention strategy 5.
• However, the decision to use aspirin should be individualized, taking into account the patient's overall risk profile, including their risk of bleeding and other comorbidities 2, 3.
• The American Diabetes Association and other organizations have published guidelines for the use of aspirin in patients with diabetes, which recommend considering aspirin therapy for primary prevention in patients with a high risk of cardiovascular events 5.

Specific Considerations for a 59-year-old Female with Type 2 Diabetes Mellitus and Hypertension

• The patient's age, sex, and presence of hypertension increase her risk of cardiovascular events, and aspirin therapy may be considered as part of her prevention strategy 2, 3.
• However, the patient's individual risk profile, including her risk of bleeding and other comorbidities, should be carefully evaluated before initiating aspirin therapy 2, 3.
• The use of aspirin in this patient should be guided by current clinical guidelines and evidence-based recommendations, and should be individualized to her specific needs and risk profile 5, 4.