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-pat Continue reading