The survey findings suggest that insufficient numbers of Americans with diabetes are aware of the cardio-protective benefits of aspirin.
Survey results released today by the American College of Preventive Medicine (ACPM) found that nearly half (48%) of U.S. adults 40+ with diabetes are not utilizing aspirin therapy to reduce their risk of recurrent heart attack or stroke nor had they reported discussing such therapy with their healthcare provider. This population is at heightened risk of cardiovascular (CV) events, and therefore potential candidates for doctor-recommended aspirin therapy based on current American Diabetes Association and U.S. Preventive Services Task Force (USPSTF) guidelines.
Heart attack and stroke are the most life-threatening consequences of diabetes, occurring more than twice as often among people with diabetes than in those who do not have the disease and accounting for approximately 65% of deaths in people with diabetes. According to the American Diabetes Association (ADA), a diagnosis of diabetes as an adult presents a similar level of coronary heart disease (CHD) risk as already having suffered a heart attack. The ADA recommends that aspirin be considered for use in the prevention of both first and recurrent CV events in patients with diabetes who have at least one additional risk factor. Additionally, the USPSTF recommends the consideration of low-dose aspirin in people whose five-year CHD risk exceeds 3%, a point at which the benefits of aspirin therapy are thought to outweigh the risks; the USPSTF recommendations also note that patients with diabetes appear to benefit "as much or more from aspirin as nondiabetic patients." Despite these treatment guidelines, the ACPM survey suggests that aspirin remains underutilized in people with diabetes, an issue that may be due in part to these individuals’ tendency to underestimate their risk for a heart attack or stroke.
"The survey findings suggest that insufficient numbers of Americans with diabetes are aware of the cardio-protective benefits of aspirin," commented George K. Anderson, MD, MPH, past president of the ACPM. Although the benefits of aspirin therapy have been proven to outweigh the risks in moderate to high risk populations, it is concerning that so many people with diabetes and at least one additional risk factor – a population that would stand to benefit from aspirin use – seem unaware of this fact," said Dr. Anderson. "Clearly, health professionals and patients – especially patients with diabetes age 40 or older – need to work together more closely to improve dialogue regarding aspirin therapy as part of a risk-reduction action plan."
The results were drawn from a nationally representative on-line survey of 1,299 U.S. adult consumers (647 men, 652 women) age 40 and over and 528 healthcare professionals. The survey was designed to assess barriers, beliefs and behaviors related to adoption of cardiovascular event prevention strategies, with a particular focus on aspirin use and adherence.
Of the 1,299 survey respondents, 198 (approximately 15%) indicated that they have diabetes. Whereas 52% of respondents with diabetes reported that they take aspirin on a regular or daily basis, 11% said they had previously used aspirin for prevention of heart attack or stroke, and 45% said they had never taken aspirin for this purpose. While nearly half of the diabetic respondents said they consider themselves "extremely knowledgeable" about aspirin therapy only 25% of the diabetic respondents said they strongly agree with the statement, "The benefits of aspirin therapy generally outweigh the risks."
The survey findings suggest that healthcare professionals believe they are discussing the risks and benefits of aspirin therapy with their patients with diabetes more frequently than patients report having this discussion with their healthcare provider. Although the survey did not explore the underlying reasons for patient behaviors, there was a significantly smaller percentage of diabetic respondents reporting aspirin use (52%), as compared with those reporting implementation of lifestyle changes (86%) and use of prescription medication (81%).
"Although the survey did not quantify how often healthcare professionals recommended aspirin, or how many patients received this recommendation, the disparity in consumer and professional responses suggests that many candidates for aspirin need to understand their risk and take action by talking to their doctor about aspirin," said Dr. Anderson. "While this is true for the population as a whole, the need for improved physician/patient communication surrounding aspirin is particularly pronounced for individuals with diabetes, given the heightened level of risk and suboptimal utilization in this patient group."
American College of Preventive Medicine (ACPM)
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