[acb-diabetics] use of aspirin not a cure all for all diabetics

[Patricia LaFrance-Wolf]

ADA and AHA Issues Statement Urging Caution for Primary-Prevention Aspirin
in Patients with Diabetes

A new scientific statement on the use of aspirin for the primary prevention
of cardiovascular disease in patients with diabetes recommends that low-dose

aspirin is "reasonable" in those with no history of vascular disease but who
are at an increased 10-year risk of cardiovascular events....  

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This article originally posted 08 June, 2010 and appeared in  

Issue 525

 

ADA and AHA Issues Statement Urging Caution for Primary-Prevention Aspirin
in Patients with Diabetes

 

A new scientific statement on the use of aspirin for the primary prevention
of cardiovascular disease in patients with diabetes recommends that low-dose

aspirin is "reasonable" in those with no history of vascular disease but who
are at an increased 10-year risk of cardiovascular events.... 

 

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The new recommendations, from a joint statement of the American Diabetes
Association (ADA), the American Heart Association (AHA), and the American
College

of Cardiology (ACC), essentially call for tighter criteria for aspirin use
in the diabetic population. The organizations state that only men older than

50 and women older than 60 who have one or more additional major risk
factors should be treated with aspirin for primary prevention of
cardiovascular events.

 

Dr. Sue Kirkman (ADA, Alexandria, VA), a member of the writing committee
stated that, "The guidelines are more conservative, or there is less of a
general

recommendation for aspirin than there used to be, and this is based on some
of the newer studies that have come out.... The previous recommendations had

been that anybody with diabetes over the age of 40 should be on aspirin."

 

The group recommends low-dose aspirin, 75 mg/d to 162 mg/d, for adults with
diabetes and no history of cardiovascular disease but who are at an
increased

risk based on age and at least one additional cardiovascular disease risk
factor, such as smoking, dyslipidemia, hypertension, family history of
disease,

and albuminuria. It is a class IIa recommendation with a level of evidence
B.

 

Aspirin is not recommended for high-risk diabetes patients who are also at
risk for bleeding and is not recommended for individuals at low risk of
cardiovascular

events. For those at intermediate risk, the use of aspirin can be
"considered" until further research is available.

 

The recommendations of the group are based on an analysis of the available
evidence with aspirin in primary prevention of cardiovascular disease for
diabetic

patients.

 

With no single study providing definitive results, the writing committee
attempted to reconcile the findings by examining existing meta-analyses.

 

Dr. Kirkman stated that, "In light of the summary of the existing literature
and the more conservative recommendations, doctors should use clinical
judgment

when treating a patient with diabetes. "The main thing is to think about the
individual patient, in terms of trying to assess their particular risk for

cardiovascular events, and whether it's high enough to warrant aspirin
therapy.... This is not a one-size-fits-all approach simply because a
patient has

diabetes."

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