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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 of 75-162mg daily.

In conclusion, there is evidence for use of aspirin in primary prevention of cardiovascular disease with diabetes. Aspirin recommendation should be based on a patient’s individual health characteristics, family history, cardiovascular risk factors, as well as their medication history so clinicians and patients alike can make informed judgments regarding their health.

Practice Pearls:
  • Aspirin therapy is not without its risks; an evaluation of risks versus benefits should be performed for each patients.
  • The use of low dose aspirin is not recommended for those who have a low risk of cardiovascular disease with no additional major risk factors.
  • A dose range of 75-162mg of aspirin daily is recommended, as a specific optimal dose has not been clearly established by current literature for the prevention of cardiovascular events.

Diabetes/Metabolism Research & Reviews 2014. Steven Rivor, PharmD Candidate 2014 Neumiler, J. J. et al. “Aspirin Therapy in Patients with Diabetes: An Update on Current Recommendations” Diabetes Spectrum; Summer 2013; 26, 3: 153-155