Should diabetes patients be taking aspirin for heart attack prevention?

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aspirin for heart attack prevention

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A recent study in the NEJM looked at whether taking aspirin for heart attack prevention is safe and effective in diabetes patients.

An estimated 400 million people worldwide have diabetes. Patients with diabetes have a two to three times greater risk of cardiovascular disease. Cardiovascular disease includes conditions that affect your heart or blood vessels, such as coronary heart disease (clogged arteries) which can lead to heart attack, chest pain or stroke. Taking aspirin for heart attack prevention has been found to be an effective treatment for patients with heart disease, but it is unclear whether it would also be beneficial for patients with diabetes who have not previously had any cardiovascular problems.

Aspirin helps prevent blood clotting

Aspirin helps prevent or reduce blood clotting. Blood clotting is when your blood’s clotting cells, called platelets, clump together to stop bleeding. However, they can also form in vessels supplying blood to your heart. If a clot forms and blocks an artery, blood flow to the heart is blocked and can cause a heart attack. Aspirin has been shown to reduce the clumping action of platelets. Therefore, taking aspirin for heart attack prevention is common among patients who have cardiovascular disease.

Previous research has shown that taking aspirin has led to a 12% lower risk of serious cardiovascular or heart problems occurring, however, it has also shown a 50% higher risk of bleeding. This side effect counterbalances the benefit of aspirin for low-risk patients with cardiovascular disease. Studies have also provided evidence that taking low-dose aspirin could potentially reduce the incidence of cancer or death from cancer by 15 – 20% compared to the control. However, these findings included only a small number of patients with diabetes. Therefore, researchers in the UK recently conducted a randomized trial to look at the effectiveness and safety of aspirin use compared with placebo in patients with diabetes who have no evidence of previous cardiovascular disease. The results were published in The New England Journal of Medicine. The trial included 15,480 adult participants who had diabetes and no previous record of cardiovascular disease. They were randomly assigned either a daily dose of 100 mg of aspirin or matching placebo.

Benefits of aspirin for heart attack prevention outweigh potential risks

The results showed that during a follow-up after an average 7.4 years, participants who received aspirin were less likely to have had a serious cardiovascular problem occur compared to the placebo group. Although, major bleeding events occurred in a higher number of participants in the aspirin group in comparison with participants in the placebo group. No significant difference was observed between the two groups in the incidence of gastrointestinal cancer or all cancers.

These findings show while aspirin was effective for preventing serious cardiovascular problems occurring in patients with diabetes who had no previous problems, it also caused major bleeding. However, the benefits of taking aspirin for heart attack prevention and reducing the risk of developing other serious cardiovascular or heart problems largely outweigh the risk of bleeding Long-term follow-up is required to assess longer-term effects and the reliability of the incidence of cancer.

Written by Lacey Hizartzidis, PhD

Reference:

  1. Daily aspirin therapy: Understand the benefits and risks. Mayo Clinic website https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797. Accessed August 31st, 2018.
  2. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med. August 2018. doi:10.1056/NEJMoa1804988.

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