In Diabetes Patients at Low CVD Risk, Aspirin Not Recommended

Risks of bleeding do not outweigh benefits, according to joint statement
By Lindsey Marcellin
HealthDay Reporter

THURSDAY, May 27 (HealthDay News) -- Low-dose aspirin for prevention of cardiovascular disease (CVD) is reasonable for adults with diabetes who are at increased CVD risk but should not be routinely recommended for those at low CVD risk, according to a combined statement from the American Diabetes Association, the American Heart Association, and the American College of Cardiology Foundation, published online May 27 in Circulation, Diabetes Care, and the Journal of the American College of Cardiology.

Michael Pignone, M.D., of the University of North Carolina at Chapel Hill, and colleagues conducted a review and meta-analysis of the literature for evidence regarding aspirin for the prevention of CVD in people with diabetes, its potential harms, and selection of appropriate patients with diabetes for aspirin CVD prophylaxis.

The researchers found a non-conclusive, modest-sized, reduction in myocardial infarction and stroke in individuals with diabetes taking aspirin. They also cited a 55 percent increased risk of extracranial bleeding in diabetes patients taking aspirin compared to those without diabetes taking aspirin. They write that the evidence suggests that low-dose (75 to 162 mg/d) aspirin for CVD prevention is reasonable for adults with diabetes and no previous history of vascular disease who are at increased CVD risk and who are not at increased risk for bleeding. However, they determined that aspirin should not be recommended for CVD prevention for adults with diabetes at low CVD risk -- as potential adverse effects from bleeding offset potential benefits -- but might be considered for those with diabetes at intermediate CVD risk.

"Two ongoing studies will provide additional information on the role of low-dose aspirin for the prevention of cardiovascular events specifically in patients with diabetes," the authors write. "Although these trials will provide important additional information, it is possible that they will not definitively determine whether aspirin is effective for prevention of CHD events in people with diabetes. This may be especially true for important subgroups such as patients on statins, women, and patients with type 1 diabetes."

One of the authors disclosed a financial relationship with Bayer Inc.

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