Aspirin no longer in the water supply for diabetics


It used to be that anyone over middle age should be on aspirin – seemingly low risk and very beneficial. According to a new position statement from the ADA/AHA/ACC, aspirin should be used based purely on the patient’s cardiovascular risk profile, balanced with their risk of bleeding.

Overall, aspirin reduces the rate of cardiovascular events by about 10%, but the risks can’t be ignored however, primarily that of haemorrhagic stroke (about 1 in 10,000) and gastrointestinal bleeding (about a 54% increased risk). 

They do make a couple of recommendations:

  • low dose aspirin use for prevention is reasonable for adults with diabetes and no previous history of vascular disease who are:
    • at increased risk of CVD risk (10 year CVD risk >10%)
      • men >50 OR women > 60 with 1 or more of
        • smoking
        • hypertension
        • dyslipidaemia
        • family history of premature CVD
        • albuminuria
    • not at increased risk of bleeding
      • no previous GI bleeds
      • no peptic ulcer disease
      • not on drugs to increase bleeding risk
        • NSAIDs
        • warfarin
They then say that aspirin is not recommended if you have diabetes but have a low CVD risk (<5%), as the adverse effects from bleeding offset the benefits. Of course, that leaves the group with a CVD risk of 5-10%, for which they say aspirin ‘might be considered’. Hmmm.

They do suggest some risk prediction tools, such as:

  • ARIC
  • ADA

Note that the above is mostly level C evidence, with that last point being ADA level E evidence. Clearly, more evidence is required with more big studies, but until then, it looks like diabetes by itself without extra coronary risk factors doesn’t warrant aspirin. What’s your practice?

See the full statement here

IMAGE: Wikimedia Commons


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