ADA and AHA Issues Statement Urging Caution for Primary-Prevention Aspirin in Patients with Diabetes

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.

Dr. Sue Kirkman (ADA, Alexandria, VA), a member of the writing committee stated that, "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.... The previous recommendations had been that 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 diabetes 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 aspirin can be "considered" until further research is available.

The recommendations of the group are based on an analysis of the available evidence with aspirin in primary prevention of cardiovascular disease for diabetic patients.

With no single study providing definitive results, the writing committee attempted to reconcile the findings by examining existing meta-analyses.

Dr. Kirkman stated that, "In light of the summary of the existing literature and the more conservative recommendations, doctors should use clinical judgment when treating a patient with diabetes. "The main thing is to think about the individual patient, in terms of trying to assess their particular risk for cardiovascular events, and whether it's high enough to warrant aspirin therapy.... This is not a one-size-fits-all approach simply because a patient has diabetes."

May 27, 2010 in Circulation, Diabetes Care, and the Journal of the American College of Cardiology.