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Does Aspirin Prevent Heart Disease in All Diabetics?

By Daniel H. Rasolt

Posted: Thursday, November 13, 2008

(Defeat Diabetes® News) -- It's often recommended that diabetics take aspirin as a method for preventing heart disease. Unfortunately, past research supporting this recommendation has been relatively inconclusive, and a recent study suggests that this preventative measure is not as universally effective as generally believed, though perhaps suitable in certain groups.
Diabetes is one of the leading risk factors for cardiovascular disease (CVD). The authors of the current study note that "individuals with diabetes have a two- to four-fold increased risk of developing cardiovascular events than those without diabetes." Diabetes incidence is on the rise throughout the world, but some of the rapidly growing (economically and population) Asian nations are expected to perhaps suffer the most. The authors stress that "myocardial infarction [heart attack] and ischemic stroke are leading causes of mortality and morbidity in patients with type 2 diabetes. Given the rapid increase in the number of patients with type 2 diabetes worldwide and especially in Asia, establishing effective means of primary prevention of coronary and cerebrovascular events is an important public health priority."
Aspirin has long been believed to have preventative abilities in concern with CVD due to its blood-thinning properties. These properties were thought to be extremely beneficial for diabetics, who are at increased risk for CVD. In fact, "American Diabetes Association recommends use of aspirin as a primary prevention strategy in patients with diabetes who are at increased cardiovascular risk," claim the authors.
In a related JAMA editorial, Dr. Antonio Nicolucci addresses the deficiency of evidence that support diabetics use of aspirin. He says that "the use of aspirin for primary prevention of cardiovascular events in individuals with diabetes is widely recommended by existing guidelines, but the evidence supporting its efficacy is surprisingly scarce." This scarcity of evidence motivated the current study, which investigated the effects of low-dose aspirin on diabetics, and its ability in preventing Cardiovascular events (CVE - this includes heart attacks, strokes and "peripheral vascular events).
Specifically, the study in question focused on 2,539 type 2 diabetes patients with no prior history of atherosclerosis (a hardening of the arteries caused by plaque buildup), over a 6 year period. 55% of study participants were men, and the average overall age was 65 years. The study was conducted through 163 different institutions in Japan.
Patients were randomly separated into a low-dose aspirin group (defined as a daily intake of 81-100 mg of aspirin), and a non-aspirin group. Through follow-up visits and analysis (some of course were unable to make a follow-up visit), it was noted which individuals suffered a CVE, including fatal and non-fatal events.
The main observations of the researchers are as follows: "A total of 154 atherosclerotic events occurred: 68 in the aspirin group and 86 in the non-aspirin group. "The 1,363 patients aged 65 years or older (719 in the aspirin group and 644 in the non-aspirin group), the incidence of atherosclerotic events was significantly lower in the aspirin group (45 events, 6.3 percent) than in the non-aspirin group (59 events, 9.2 percent)." While these represent the potentially positive effects of low-dose aspirin consumption, there was no overall beneficial effect observed in the 1,176 patients under 65 years of age.
The above results again do not conclusively establish aspirin's ability in preventing CVD for diabetics, but it gives a strong basis for more conclusive future research. The fact that the study was conducted in Japan (a place with the lowest incidence of CVD in the world), with somewhat different results than are usually referenced in western countries, lends credence to the notion that the complexities of aspirin use are greater than as a simple blood-thinner.
The authors conclude that "these findings should be interpreted in context with the low incidence of atherosclerotic disease in Japan and the current management practice for cardiovascular risk factors and suggest the need to conduct additional studies of aspirin for primary prevention of cardiovascular disease in diabetic patients."

Source: Defeat Diabetes Foundation: Ogawa, Hisao. JAMA press release. November 2008. Nicolucci, Antonio. JAMA Editorial: "Aspirin For Primary Prevention – Still an Open Question for Patients with Diabetes." November 2008.

Daniel H. Rasolt writes for Defeat Diabetes® News. Read more of his original content articles.

Copyright © 2008 Defeat Diabetes Foundation, Inc. All rights reserved.

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