Aspirin recommended for diabetes patients at high CVD risk
MedWire News: A joint scientific statement released by the American College of Cardiology, the American Diabetes Association, and the American Heart Association, recommends that diabetic men over 50 and women over 60 years who have at least one additional risk factor for cardiovascular disease (CVD) should be considered for low-dose aspirin therapy.
“Because the relative risk reduction appears to be modest, the panel felt that we are on strongest ground recommending aspirin for those at increased CVD risk, defined by the age categories and risk factors mentioned or by a calculation of CVD risk,” said lead author of the statement Michael Pignone from the University of North Carolina in Chapel Hill, USA.
“We felt that the benefits were likely to exceed the downsides, such as gastrointestinal bleeding, for the groups mentioned. There will be some younger people with sufficient risk to warrant aspirin, but many who are not at sufficient risk.”
Treatment with low-dose aspirin has been shown to be effective for secondary prevention in nondiabetic high-risk patients with previous myocardial infarction or stroke. In addition, low-dose aspirin use for primary prevention purposes was recently recommended by the US Preventive Services Task Force in men aged 45–79 years and women aged 55–79 years, but no differentiation based on diabetes status was suggested.
The current statement was released to try and clarify the situation for clinicians, as several recent trials carried out to determine whether aspirin is beneficial for CVD prevention in people with Type 2 diabetes have had mixed results, as reported by MedWire News.
The authors of the statement say that more research is required to better define the effects of aspirin in patients with diabetes, as well as possible gender-specific differences. They say that although a modest benefit is suggested, the “current evidence is not conclusive because there have been too few events in the available trials to precisely estimate its effects.”
They suggest that low-dose (75–162 mg/day) aspirin therapy should be given to patients with diabetes with a 10-year risk for CVD above 10%, but not to diabetics with low CVD risk (men under 60 and women under 50 years with no CVD risk factors).
They note that in the absence of further evidence, diabetic patients who are at intermediate risk (older with no CVD risk factors, or younger with CVD risk factors) can also be considered for low-dose aspirin treatment at the discretion of their clinician.
The statement is published in the journal Circulation, as well as in the Journal of the American College of Cardiology and Diabetes Care.
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By Helen Albert