Preventive aspirin reasonable for diabetics at high risk, not low

Guidance on how to use aspirin for primary prevention of cardiovascular events in diabetics was offered in a recent statement from the American Diabetes Association, the American Heart Association and the American College of Cardiology Foundation.

Aspirin use provides a modest (about 10%) reduction in cardiovascular events overall, but its effect as primary prevention in diabetics is unclear, the experts concluded after an evidence review. However, it's reasonable to use low-dose (75 to 162 mg/d) aspirin as prevention in diabetics who have an increased risk of cardiovascular disease (a 10-year risk over 10%), the statement said. That would include most men over 50 and women over 60 who have one or more additional risk factors: smoking, hypertension, dyslipidemia, family history of premature cardiovascular disease or albuminuria.

For patients at intermediate risk (younger patients with one or more of the risk factors, older patients with no risk factors, or anyone with a 10-year risk of 5% to 10%), preventive aspirin might be considered, the experts said. However, patients at low risk (those with a 10-year risk under 5%) should not be advised to take aspirin, as the potential adverse effects from bleeding offset the potential benefits. The statement noted that patients with diabetes are at higher risk for adverse events from aspirin than nondiabetics.

When calculating a patient's risk of cardiovascular disease, physicians should also consider the beneficial effects of other treatments such as statins, blood pressure control and smoking cessation. If these other treatments are adopted first, then there may be less need for aspirin, the statement said. The statement concluded by calling for additional research to better define the effects of aspirin in diabetes, including any sex-specific differences. The statement was published online by Circulation on May 27.