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 >>
Aspirin And Diabetes
June 3, 2010 (Chapel Hill, North Carolina) 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 . 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. "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," Dr Sue Kirkman (ADA, Alexandria, VA), a member of the writing committee, told heartwire . "The previous recommendations had been that pretty much 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 diabetic 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 as Continue reading >>
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 >>
Aspirin And Diabetes Good For The Heart?
In my last post I set the stage for talking about aspirin in the context of diabetes. There is quite a lot to talk about. Lets start with heart disease. People with diabetes are at a much greater risk of developing various forms of heart disease. This is the case for both type I and type II. One study , analyzing aspirin usage in a US diabetic population, estimated that approximately 14% of their study population had a heart attack, 11% had a stroke, and 8% experience angina. Over 70% of them had one or more risk factors elevating their relative risk from 2 to 4 times that of a non-diabetic person. Since it has been known for some time that low dose aspirin decreases the risk of stroke, the ADA has been promoting its use for diabetic patients for a number of years. By low dose I mean really low dose. Think of an aspirin tablet. Bayer Aspirin, for example, is 300 mg. You might take as many as 3 tablets to get a decent response but you will probably take at least 1 tablet. If you were taking this drug on a low dose regimen you would cut the tablet in 4 and take a quarter tab per day. The mechanism by which low dose aspirin makes this happen is quite interesting and worth a paragraph or three. Stroke is caused by blood clots which get stuck in capillaries and block the flow of nutrients to critical brain regions. The cell which initiates clotting is called the platelet. Platelets, for some reason, do not have nuclei. They are actually pinched off pieces of a larger cell called a megakaryocyte . Since they only live for about 10 days I guess they dont need it but this lack of a nucleus does have some consequences. The nucleus is the place where DNA is found and, of course, DNA is the template for making new proteins. No DNAno new proteins. The cell is stuck with what it ha Continue reading >>
Diabetes...an Aspirin A Day
DOCTOR'S VIEW ARCHIVE Medical Author: Ruchi Mathur, M.D. Medical Editor: William C. 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 was remarkable and very successful. At age 62, she had managed to change her lifestyle completely around. I saw this patient in follow-up last week and told her 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 frown and said: " I thought you said I didn't need any medication. You know how much I despise the thought of taking pills. What's this all about?" The prescription I wrote was for coated aspirin. It had nothing to do with 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 of thromboxane, 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 after a heart attack (secondary prevention t Continue reading >>
Recommending Aspirin For Primary Prevention In Diabetic Patients: What May We Conclude From The Data?
Recommending Aspirin for Primary Prevention in Diabetic Patients: What May We Conclude from the Data? Author information Copyright and License information Disclaimer Cardiovascular (CV) disease is the leading cause of morbidity and is responsible for premature mortality in patients with diabetes [ King et al. 1998 ]. In addition to its association with multiple classical CV risk factors, diabetes is associated with accelerated atherosclerosis and inflammation that contribute to the pathogenesis and progression of vascular complications [ Evangelista et al. 2005 ]. For this reason, antiplatelet therapy is considered an essential component of diabetes care to reduce ischemic risk [ Angiolillo, 2009 ]. Aspirin has been on the market since 1899, and is still one of the most widely used medications for the treatment and prevention of CV disease. Despite such a long history of use, the role of aspirin for the primary prevention of CV events in individuals with diabetes is still a matter of debate. The new evidence made available in the last few years seems to have increased, rather than resolved, all the doubts regarding the risk-benefit profile of antiplatelet therapy. The uncertainty surrounding this topic is clearly demonstrated by the extreme heterogeneity in the recommendations issued by different scientific societies. As an example, until 2008, the American Diabetes Association recommended the use of aspirin for primary prevention of CV events in all individuals aged over 40 years or with additional risk factors [ American Diabetes Association, 2008 ]. This recommendation was graded as A, that is, supported by evidence of the highest quality. In 2009, while maintaining the same recommendation, grading was changed to C (evidence from poorly controlled studies) [ America Continue reading >>
Aspirin Guidelines For People With Diabetes
Aspirin Guidelines for People with Diabetes Aspirin Guidelines for People with Diabetes Its important for everyone to live a heart-healthy lifestyle, but its especially true if you have diabetes.If you havediabetes, youare three times more likely than others to experience cardiovascular events. Although the statistic is unsettling, it doesnt mean it has to be true for you. In fact, there is a lot you can do to reduce your riskfor heart disease. One way that may benefit you: taking an aspirin a day. Aspirin is known for its heart-healthy properties. Experts believe that it reduces your chance for heart attack and stroke.It prevents blood from clotting too much. However, for some, it can cause more harm than good. Despite its heart-related benefits, aspirin can cause gastrointestinal bleeding. It can also causeintracranial bleeding. Thiscan lead to a hemorrhagic stroke. On top of tracking your diet and blood sugar, regular exercise is a key part of managing your diabetes. And while any exercise is better than none, certain activities have specific benefits for people with diabetes. 2018Healthgrades Operating Company, Inc. All rights reserved. May not be reproducedor reprinted without permission from Healthgrades Operating Company, Inc. Useof this information is governed by the Healthgrades User Agreement. Experts have studied the effects of aspirinon people with diabetes. They have found that one size doesnt fit all. In other words, aspirin therapy is right for some people, but not for others.Some people with diabetes are also at increased risk for bleeding issues.Its very important that the benefits of taking aspirin outweigh the risks. For some people with diabetes, experts give the green light for daily aspirin use. Some get a red lightfor aspirin therapy. Thismeans t 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 >>
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?
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 >>
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 >>
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 >>
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 >>