Should Patients With Type 2 Diabetes Take Aspirin To Prevent Stroke And Coronary Events?
What is the role of aspirin in primary prevention — preventing the first cardiovascular event in our patients? This has been an area of changing recommendations leading to considerable uncertainty among practitioners. Aspirin is an effective antiplatelet agent that acts by inhibiting cyclooxygenase-1 (COX-1) which leads to reduced levels of thromboxane A2, a potent promoter of platelet aggregation. It is therefore widely used in high-risk individuals to prevent myocardial infarction and stroke. It may also reduce the risk of colorectal cancer. However, aspirin use is not without risks — the reduced platelet action increases the risk of gastrointestinal bleeding and hemorrhagic strokes. When aspirin is used for secondary prevention — to reduce the risk of recurrent myocardial infarction or ischemic stroke in patients with established cardiovascular disease — the risk of a recurrent cardiovascular event is so high that the benefits of aspirin greatly outweigh the risks. But what about aspirin in primary prevention? Many patients who present with myocardial infarction or ischemic stroke have no previous history of cardiovascular disease but may have been at high risk for such disease due to risk factors such as type 2 diabetes. NEJM Knowledge+ Internal Medicine Board Review includes the following question on this very topic; we have heard from many learners that they are uncertain about the current recommendations. The Case & Question A 44-year-old man with hypertension, hyperlipidemia, obesity, type 2 diabetes, and paroxysmal atrial fibrillation presents for a new-patient visit. He feels well and has no complaints. His current medications include metformin 1000 mg twice daily, metoprolol extended-release 75 mg once daily, lisinopril 20 mg once daily, simvastatin 2 Continue reading >>
New Aspirin Guidelines For Diabetes Patients
June 2, 2010 -- Women under 60 and men under 50 who have diabetes but no other major risk factors for heart disease probably should not be on low-dose aspirin therapy, new research suggests. The new recommendations are based on close examination of nine studies that found the risks of some aspirin side effects, such as stomach bleeding, should be better balanced against the possible benefits of using aspirin. The new guidelines suggest low-dose aspirin therapy be used by men over 50 and women over 60 with diabetes who have other risk factors for heart attack and stroke. The U.S. Preventive Services Task Force still recommends low-dose aspirin for prevention of heart attacks and stroke in men aged 45 to 79 and women aged 55 to 79. The new guidelines have been endorsed by a panel of experts from the American Diabetes Association, the American Heart Association, and the American College of Cardiology Foundation. "The larger theme here is that use of low-dose aspirin to prevent heart attacks in people who have not already experienced one is probably not as efficacious as we used to believe it was," Craig Williams, PharmD, an associate professor in the College of Pharmacy at Oregon State University, says in a news release. Williams, one of those on the recent review panel, says doctors need to balance the benefits of any medication against possible side effects, and that even low-dose baby aspirin has some degree of risk, even though it is very low. "[We] have to be able to show clear benefits that outweigh that risk," he says. "In the case of young adults with diabetes but no other significant risk factors, it's not quite clear that the benefits are adequate to merit use of aspirin." People with diabetes face a higher risk of heart disease as they age, and many doctors have Continue reading >>
Low-dose Aspirin Therapy In Patients With Type 2 Diabetes And Reduced Glomerular Filtration Rate
Low-Dose Aspirin Therapy in Patients With Type 2 Diabetes and Reduced Glomerular Filtration Rate Yoshihiko Saito , MD, PHD,1 Takeshi Morimoto , MD, PHD,2 Hisao Ogawa , MD, PHD,3 Masafumi Nakayama , MD, PHD,3 Shiro Uemura , MD, PHD,1 Naofumi Doi , MD, PHD,1 Hideaki Jinnouchi , MD, PHD,4 Masako Waki , MD, PHD,5 Hirofumi Soejima , MD, PHD,3 Seigo Sugiyama , MD, PHD,3 Sadanori Okada , MD,1 Yasuhiro Akai , MD, PHD,1 and on behalf of the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators 1First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan 2Center for Medical Education, Kyoto University Graduate School of Medicine, Kyoto, Japan 3Department of Cardiovascular Medicine, Graduate Medical School of Medical Science, Kumamoto University, Kumamoto, Japan 5Division of Endocrinology and Metabolism, Department of Internal Medicine, Shizuoka City Hospital, Shizuoka, Japan Corresponding author: Yoshihiko Saito, [email protected] . Received 2010 Aug 20; Accepted 2010 Nov 6. Copyright 2011 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See for details. This article has been cited by other articles in PMC. Type 2 diabetes accompanied by renal damage is a strong risk factor for atherosclerotic events. The purpose of this study was to investigate the efficacy of low-dose aspirin therapy on primary prevention of atherosclerotic events in patients with type 2 diabetes and coexisting renal dysfunction. The Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial was a prospective, randomized, open-label trial conducted throughout Japan that enrolled Continue reading >>
Diabetes - An Aspirin A Day
home / diabetes center / diabetes a-z list /diabetes: an aspirin a day article Medical Editor: WilliamC. Shiel Jr., MD, FACP, FACR A patient came into my office a few months ago with newly diagnosed diabetes . We had decided to manage her diabetes with a trial of diet and exercise . She was very compliant and was trying desperately to change her lifestyle to avoid being on medication. She started walking regularly and was reading every label on every item of food she bought. Her enthusiasm to control her disease wasremarkable and very successful. At age 62, she had managed to change herlifestyle completely around. I saw this patient in follow-up last week and toldher how very impressed I was with her progress. She had managed to control her diabetes with diet and exercise and did not need medication to control her blood sugar at this time. Her blood pressure was under control and her cholesterol levels were well within the normal range. She was thrilled. As we concluded our visit, I handed her a prescription. She took it with a frownand said: " I thought you said I didn't need any medication. You know howmuch I despise the thought of taking pills. What's this all about?"The prescription I wrote was for coated aspirin . It had nothing to dowith her blood sugar control - well not directly. People with diabetes have a two to four fold increase in the risk for dying from heart disease . A major contributor to this risk is an increased production ofthromboxane, a substance which causes vessels to constrict and also causes platelets (the cells that are responsible for clotting) to stick together and form clots inside of arteries. Aspirin blocks the production of thromboxane. Many large trials have shown a benefit of aspirin therapy in men and women aftera heart attack (secon Continue reading >>
Mechanism By Which High-dose Aspirin Improves Glucose Metabolism In Type 2 Diabetes
Mechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes Ripudaman S. Hundal ,1 Kitt F. Petersen ,1 Adam B. Mayerson ,1 Pritpal S. Randhawa ,1 Silvio Inzucchi ,1 Steven E. Shoelson ,2 and Gerald I. Shulman 1,3,4 1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA2 Joslin Diabetes Center and the Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA3 Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA4 Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA 1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA2 Joslin Diabetes Center and the Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA3 Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA4 Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA 1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA2 Joslin Diabetes Center and the Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA3 Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connecticut, USA4 Howard Hughes Medical Institute, Yale University School of Medicine, New Haven, Connecticut, USA 1Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA2 Joslin Diabetes Center and the Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA3 Department of Cellular and Molecular Physiology, Yale University School of Medicine, New Haven, Connect Continue reading >>
Diabetes And Aspirin
Tweet In the past, aspirin was often prescribed to people with diabetes, with the aim of reducing the risk of cardiovascular disease as a diabetes complication. However, concerns over an increased risk of bleeding associated with aspirin have led to recent new guidelines for aspirin for diabetics in the UK. Aspirin: revised recommendations In late 2009, Diabetes UK revised their recommendations regarding aspirin. They stated that people without known cardiovascular disease need to discuss their individual cases with their healthcare team, rather than taking aspirin as a preventative. Those people that are already taking aspirin were advised to continue until they have talked with their healthcare team. Diabetes UK recommends that people with diabetes who have a history of cardiovascular disease should take aspirin - including those with heart disease, stroke, transient ischemic attack and peripheral vascular disease. Effectively, the consensus is that aspirin should not be used routinely to prevent heart attacks amongst people with diabetes. Previous guidelines that suggested aspirin should be used by diabetics to counter the risk of heart attack and stroke are now invalid. That said, some high-risk groups should still use aspirin to lower their risk. Patients with diabetes should discuss their aspirin use with their healthcare professional. The fact remains that amongst people who have had a heart attack or stroke, aspirin has been shown to reduce the risk of future cardiovascular events by a significant amount. The risk of stomach bleeding needs to be carefully considered and discussed with your healthcare team. What the community are saying about hypos? Foreman: I have stopped taking low dose aspirin following advice from a consultant. Now my GP wants to restart me o Continue reading >>
Aspirin Therapy In Diabetes
These pages are best viewed with Netscape version 3.0 or higher or Internet Explorer version 3.0 or higher. When viewed with other browsers, some characters or attributes may not be rendered correctly. Originally approved 1997. The recommendations in this article are based on the evidence reviewed in the following publication: Standards of Care for Diabetes (Technical Review). Diabetes Care 17:767-71, 1997. Reprinted with permission from Diabetes Care (Suppl. 1): 21:S45-46, 1998. eople with diabetes have a two- to fourfold increase in the risk of dying from the complications of cardiovascular disease. Both men and women are at increased risk. Atherosclerosis and vascular thrombosis are major contributors, and it is generally accepted that platelets are contributory. Platelets from men and women with diabetes are often hypersensitive in vitro to platelet aggregating agents. A major mechanism is increased production of thromboxane, a potent vasoconstrictor and platelet aggregant. Investigators have found evidence in vivo of excess thromboxane release in type 2 diabetic patients with cardiovascular disease. Aspirin blocks thromboxane synthesis by acetylating platelet cyclo-oxygenase and has been used as a primary and secondary strategy to prevent cardiovascular events in nondiabetic and diabetic individuals. Meta-analyses of these studies and large-scale collaborative trials in men and women with diabetes support the view that low-dose aspirin therapy should be prescribed as a secondary prevention strategy, if no contraindications exist. Substantial evidence suggests that low-dose aspirin therapy should also be used as a primary prevention strategy in men and women with diabetes who are at high risk for cardiovascular events.1 A meta-analysis of 145 prospective controlled Continue reading >>
Should People With Diabetes Take Aspirin? What Doctors Say | Everyday Health
Aspirin has a wide variety of uses, including potentially promoting heart health in people with type 2 diabetes. When you think about common aspirin uses, you likely think of the drug as falling in line with ibuprofen (Advil, Motrin), acetaminophen (Tylenol), and other common over-the-counter medications for pain relief. But that isnt the only potential benefit of aspirin. Aspirin has been used in many different treatments for a variety of medical issues, says Deena Adimoolam, MD , an endocrinologist at Mount Sinai in New York City. But predominantly, its mainly for diseases related to heart disease. She adds that you might also consider taking aspirin if you have a history of strokes. Aspirin is an anti-platelet agent. It thins the blood, and it helps prevent blood clotting, says Jennifer Shrodes, RD, CDE , who is on the diabetes education staff at the Ohio State University Wexner Medical Center in Columbus. If youre managing type 2 diabetes , aspirin might be helpful for warding off future health complications, too. Why Aspirin and Diabetes Might Make a Good Match The main benefit of aspirin for people with type 2 diabetes relates to the drugs potential effect on cardiac health . Heart disease is the primary cause of preventable death worldwide, according to the Centers for Disease Control and Prevention (CDC) , and people with diabetes should be particularly mindful of their increased risk for heart disease. According to the American Heart Association (AHA) , at least 68 percent of people age 65 or older who have diabetes die from some form of heart disease, and adults with diabetes are 2 to 4 times more likely to die from heart disease as adults without diabetes. In addition, the American Diabetes Association (ADA) recommends that people with diabetes be assessed a Continue reading >>
Does Aspirin Do Much Good?
Should people who have diabetes but no signs of cardiovascular disease take aspirin to help reduce their risk of heart attack and stroke ? Studies have shown that aspirin helps prevent additional heart attacks and strokes in people who have already had one. And since having diabetes puts people at an increased risk of having a heart attack or stroke, the American Heart Association recommends aspirin therapy. However, two studies published late last year have called this practice into question. The first study, published in the journal BMJ in October 2008, enrolled 1,276 people in Scotland aged 40 and up. These people had Type 1 or Type 2 diabetes and no symptoms of cardiovascular disease. The participants were randomly assigned to take one of four combinations of pills: a low-dose (100 milligrams [mg]) tablet of aspirin plus an antioxidant capsule; the aspirin plus a placebo (inactive) capsule, a placebo tablet plus an antioxidant capsule; or a placebo tablet plus a placebo capsule. Neither the participants nor their doctors knew which treatment they were receiving. After about six years, the researchers found no significant difference in rates of cardiovascular events, such as heart attack or stroke, in any of the groups. They concluded that neither aspirin nor antioxidants helped prevent cardiovascular events in the people with diabetes who were studied. The second study was published on November 12, 2008, in The Journal of the American Medical Assocation. It took place in Japan and enrolled 2,539 people with Type 2 diabetes and no history of cardiovascular disease. Participants in this study were randomly assigned to take low-dose aspirin (either 81 mg or 100 mg) or no aspirin. There was no placebo group, and participants knew what kind of treatment they were receiv Continue reading >>
Updated Recommendations On Aspirin Therapy In Diabetic Patients
An overview on aspirin use in the prevention of cardiovascular events…. Aspirin is a pharmaceutical drug that has been commercially available since 1899. Although originally used as a pain reliever and fever reducer, significant studies show aspirin can play a role in reducing the risk of cardiovascular disease. Patients with diabetes are at two to four fold greater risk of cardiovascular disease than those without diabetes. The updated recommendations are in response to a previous published article on aspirin therapy released in 2011. The current 2013 guideline recommendations by the American Diabetes Association (ADA) suggest aspirin therapy for primary prevention in patients with either type 1 or 2 diabetes who have an increased risk of cardiovascular disease. They do not recommend aspirin therapy in men under 50 years of age or most women under 60 years of age that have a low risk of cardiovascular disease because the risk of bleeding outweighs the potential benefits of aspirin treatment. A joint statement between the ADA, the American Heart Association, and the American College of Cardiology Foundation have provided additional recommendations for the use of aspirin in diabetics. They state that low dose aspirin is reasonable for diabetic adults who are at increased risk of cardiovascular disease (with no previous history of vascular disease) and not at an increased risk for bleeding. This includes men > 50 years old and most women > 60 years old. Aspirin is not recommended for diabetic patients who have a low risk of cardiovascular disease, such as men < 50 years old and women < 60 years old with no major risk factors. Additionally, aspirin might be recommended in those with an intermediate risk of cardiovascular disease. They also recommend an aspirin dose range Continue reading >>
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- Should Patients with Type 2 Diabetes Take Aspirin to Prevent Stroke and Coronary Events?
Low Dose Aspirin Therapy Decreases Blood Glucose Levels But Does Not Prevent Type I Diabetes-induced Bone Loss.
Abstract BACKGROUND: Diabetes is strongly associated with increased fracture risk. During T1-diabetes onset, levels of blood glucose and pro-inflammatory cytokines (including TNFα) are increased. At the same time, levels of osteoblast markers are rapidly decreased and stay decreased 40 days later at which point bone loss is clearly evident. Inflammation is known to suppress bone formation and induce bone loss. Previous co-culture studies indicate that diabetic bone is inflamed and diabetic bone marrow is capable of enhancing osteoblast death in vitro. Here we investigate a commonly used non-steroidal anti-inflammatory drug, aspirin, to prevent T1-diabetic bone loss in vivo. METHODS: We induced diabetes in 16-week-old male C57BL/6 mice and administered aspirin in the drinking water. RESULTS: Our results demonstrate that aspirin therapy reduced diabetic mouse non-fasting blood glucose levels to less than 400 mg/dl, but did not prevent trabecular and cortical bone loss. In control mice, aspirin treatment increased bone formation markers but did not affect markers of bone resorption or bone density/volume. In diabetic mice, bone formation markers and bone density/volume are decreased and unaltered by aspirin treatment. Bone resorption markers, however, are increased and 2-way ANOVA analysis demonstrates an interaction between aspirin treatment and diabetes (p<0.007). Aspirin treatment did not prevent the previously reported diabetes-induced marrow adiposity. CONCLUSION: Taken together, our results suggest that low dose aspirin therapy does not negatively impact bone density in control and diabetic mice, but could potentially increase bone resorption in T1-diabetic mice. Copyright © 2011 S. Karger AG, Basel. Continue reading >>
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Aspirin-like Drug May Help Diabetics Control Blood Sugar
Over the years, I’ve written and edited many articles for medical journals. I have to say I’m now finding it a bit odd to be on the flip side as the subject of such an article (along with 285 other people). A couple years ago, I volunteered to take part in a clinical trial testing whether an old, aspirin-like drug called salsalate could help control blood sugar in people with type 2 diabetes. The results of that trial, called TINSAL-T2D, are reported in the current issue of Annals of Internal Medicine. All 286 volunteers were given blue pills to take every day for nearly a year. Half of us got pills containing salsalate; the others got placebo pills. Over the course of the trial, those in the salsalate group had lower blood sugar levels, and some were even able to reduce dosages of other diabetes medications they were taking. “We were very pleased with the findings of the TINSAL-T2D study,” said lead author Dr. Allison B. Goldfine, associate professor of medicine at Harvard-affiliated Joslin Diabetes Center. “They indicate that salsalate, a drug that has been marketed for over 40 years for the treatment of arthritis, could be an inexpensive additional therapeutic option to treat patients with diabetes.” Inflammation and diabetes Salsalate is an old drug that’s closely related to aspirin. Use of these drugs and their natural precursor use can be traced back at least 3,500 years. Today, salsalate is used to treat arthritis pain. One advantage it has over aspirin and other nonsteroidal anti-inflammatory drugs is that it doesn’t irritate the digestive tract. No one knows exactly how salsalate helps control blood sugar. But its effectiveness supports the idea that inflammation plays a role in type 2 diabetes. In addition to improving blood sugar control, sals Continue reading >>
Aspirin Use In Patients With Diabetes Requires Careful Consideration
Aspirin use in patients with diabetes requires careful consideration American College of Cardiology 60th Annual Scientific Sessions NEW ORLEANS Aspirin has been proven to be effective in reducing the risk for cardiovascular events; however, patients with diabetes are a unique population that requires special considerations before treatment. While aspirin therapy is recommended, further exploration into dosing strategies, stronger antiplatelet therapy and the clinical interaction between aspirin and patients with diabetes is essential, a speaker said here. A landmark study published in 1990 really set the stage as to why diabetics are different and why antiplatelet therapy may be effective in this population, Jeffrey S. Berger, MD, of the NYU Cardiac and Vascular Institute at the NYU Langone Medical Center in New York, said during a presentation. Compared with nondiabetics, diabetics had greater platelet activity. Berger noted that one study currently being conducted at NYU suggests that markers of platelet activity correspond well with an increasing prevalence of diabetes, even in patients without CV disease. Data from other trials support this association, and these results raised an important question: Can measuring platelet activity prevent a future event? At present, this question remains unanswered but warrants further investigation, he said. In addition, physicians must consider dosing when treating with aspirin. Berger explained that aspirin inhibits COX-1 and, thus, reduces amounts of platelet activation and vascular constriction. However, aspirin at higher doses also reportedly inhibits prostacyclin, which causes an effect opposite of thromboxane. Therefore, Berger emphasized that physicians be careful not to prescribe too much aspirin, even among patients wit Continue reading >>
Diabetes Management: Does Aspirin Therapy Prevent Heart Problems?
I've heard that aspirin therapy may not help prevent heart problems when you have diabetes and peripheral artery disease. Should I keep taking it? Answers from M. Regina Castro, M.D. Diabetes increases your risk of heart attack and clot-related stroke (cardiovascular events). Peripheral artery disease — a condition in which your arteries narrow, reducing blood flow to your arms and legs — also increases your risk of cardiovascular events. Aspirin interferes with your blood's ability to clot. Because diabetes increases your risk of cardiovascular events, daily aspirin therapy typically has been recommended as part of a diabetes management plan. Research has shown that aspirin therapy is effective at reducing the risk of heart attack and clot-related strokes if you've had a previous cardiovascular event. Aspirin therapy also appears to reduce these risks if you're experiencing symptoms of peripheral artery disease — such as leg cramping, numbness or weakness. What's not clear is whether aspirin lowers the risk of a cardiovascular event if you haven't experienced one before and you aren't experiencing symptoms of peripheral artery disease. More study is needed on the potential benefits and risks of aspirin therapy in these people. Aspirin therapy does have potential side effects, such as bleeding ulcers and stroke caused by a leaking or burst blood vessel (hemorrhagic stroke). If you have diabetes, peripheral artery disease or both, ask your doctor about daily aspirin therapy, including which strength of aspirin would be best for you. Continue reading >>
Aspirin Therapy In Diabetes
EFFICACY Secondary prevention trials A meta-analysis of 145 prospective controlled trials of antiplatelet therapy in men and women after myocardial infarction, stroke or transient ischemic attack, or positive cardiovascular history (vascular surgery, angioplasty, angina, etc.) has been reported by the Anti-Platelet Trialists (APT) (4). Reductions in vascular events were about one-quarter in each of these categories, and diabetic subjects had risk reductions that were comparable to nondiabetic individuals. There was a trend toward increased risk reductions with doses of aspirin between 75 and 162 mg/day. It was estimated that 38 ± 12 vascular events per 1,000 diabetic patients would be prevented if they were treated with aspirin as a secondary prevention strategy. Comparable results were seen in males and females. Primary prevention trials Two studies have examined the effect of aspirin in primary prevention and have included patients with diabetes. The U.S. Physicians’ Health Study (5) was a primary prevention trial in which a low-dose aspirin regimen (325 mg every other day) was compared with placebo in male physicians. There was a 44% risk reduction in the treated group, and subgroup analyses in the diabetic physicians revealed a reduction in myocardial infarction from 10.1% (placebo) to 4.0% (aspirin), yielding a relative risk of 0.39 for the diabetic men on aspirin therapy. These results are supported by the Early Treatment Diabetic Retinopathy Study (ETDRS), a mixed primary and secondary prevention trial (6). This population consisted of type 1 and type 2 diabetic men and women, about 48% of whom had a history of cardiovascular disease. The study, therefore, may be viewed as a mixed primary and secondary prevention trial. The relative risk for myocardial infarct Continue reading >>