Experts question routine aspirin for patients with type 2 diabetes

Barcelona, Spain - The widespread recommendation for the routine use of low-dose aspirin in primary prevention of cardiovascular events for all patients with type 2 diabetes should be revisited, experts said at the European Society of Cardiology 2009 Congress. Currently, most of the major scientific bodies, including the American Heart Association (AHA), American College of Cardiology (ACC), European Society of Cardiology (ESC), and the European Association for the Study of Diabetes (EASD), uniformly recommend giving aspirin to these patients. The lone exception is the Canadian Diabetes Association, which says that the decision to prescribe aspirin should be left to the discretion of the individual physician. Yet there is inadequate trial evidence for the efficacy and safety of low-dose aspirin in this setting, Dr Carlo Patrono (Catholic University, Rome, Italy) told meeting attendees."If a patient has had a prior event, there is no question that he or she should be on aspirin, regardless of whether the patient is or is not diabetic, because we have plenty of evidence there," Patrono commented to heartwire. "But we don't have evidence for the efficacy and safety of low-dose aspirin in diabetics without a prior vascular event or without overt vascular disease. We need direct randomized evidence."Patrono was echoed by Dr Harald Darius (Vivantes Neukoelln Medical Center, Berlin, Germany), who told heartwire that recent trial results appear to contradict the general recommendations by the AHA, ACC, ESC, and EASD. "These societies recommend that every diabetic as soon as the diagnosis is made should receive aspirin as part of the initial therapeutic regimen, but they are probably overestimating the risk of diabetes in otherwise-healthy people."Indeed, aspirin may be harmful for people with diabetes. "Diabetes mellitus is not only a risk factor for the occurrence of a serious vascular event, which is increased by about two-and-a-half fold, it is also a risk factor for major bleeds, which increase by about 50% in association with diabetes. So we should be very careful in seeking adequate evidence for both efficacy and safety of aspirin in this subgroup," Patrono said.

Artículo completo: theheart.org