Diabetics Get New Criteria For Aspirin Use
By Mike Boyle

Low-dose aspirin therapy is a reasonable measure to prevent a first heart attack or stroke among people with diabetes who also have a high risk for heart disease, according to a joint scientific statement of the American College of Cardiology Foundation, the American Diabetes Association (ADA) and the American Heart Association (AHA).

People with diabetes eligible for low-dose aspirin therapy based on this guideline include most men over age 50 and most women over age 60 that have additional risk factors.

Trials to determine whether aspirin can prevent a first heart attack or stroke in adults with diabetes have had mixed results, but overall suggest that aspirin modestly reduces the risk of cardiovascular events.

More research is needed to better define the specific effects of aspirin in patients with diabetes, including gender-specific differences, according to the joint statement.

"Because the relative risk reduction appears to be modest, the panel felt that we are on strongest ground recommending aspirin for those at increased cardiovascular disease (CVD) risk, defined by the age categories and risk factors mentioned or by a calculation of CVD risk," said Michael Pignone, M.D., lead author of the statement and chief of the general medicine division and professor of medicine at the University of North Carolina in Chapel Hill.

Authors of the statement said scientific evidence to support aspirin therapy depends on the underlying CVD risk. Those with higher risk should have greater benefit, they said, but the decision to use aspirin therapy depends on the use of other treatments such as cholesterol-lowering medicines, blood pressure control and quitting smoking.

On average people with diabetes are at three times the increased risk of cardiovascular events compared with age- and sex-matched people without diabetes, according to the Centers for Disease Control and Prevention. In patients with diabetes who are older than 65, 68 percent die from coronary heart disease and 16 percent from stroke. Researchers have proposed numerous mechanisms for the increased cardiovascular risk with diabetes, including increased tendency toward clot formation, platelet activity and damage to the arterial wall lining.

In 2007, the ADA and AHA jointly recommended that aspirin therapy (75–162 mg/day) be started for both men and women above age 40 with another major risk factor, such as a family history of CVD, high blood pressure, smoking, high cholesterol or protein in the urine.

"The new recommendations only address primary prevention," said Craig Williams, PharmD., a co-author of the statement and associate professor of pharmacy and medicine at Oregon Health Sciences University in Portland Oregon. "All three organizations continue to strongly recommend low-dose aspirin for all patients who have previously had a heart attack or stroke, so-called secondary prevention."

Read a complete copy of the Position Statement of the American Diabetes Association, a Scientific Statement of the American Heart Association, and an Expert Consensus Document of the American College of Cardiology Foundation on the new criteria for aspirin use for people with diabetes here. (Note: Once there, click on the "Begin manual download" link.)


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 Originally posted June 2, 2010