Aspirin Benefits and Risks in People with Diabetes
Our expert is Simeon Margolis, M.D., Ph.D., professor of medicine and biological chemistry, Johns Hopkins Medicine.
Q: Can aspirin therapy help prevent a heart attack or stroke?
A: Clinical trials have shown that regular use of aspirin prevents heart attacks and strokes in people who have coronary artery disease or have already had a heart attack or stroke. Why? The little white pills we associate with pain relief prevent the clumping of blood platelets and the formation of clots on top of cholesterol-laden artery walls, which can block blood flow to the heart or brain.
However, aspirin can have significant side effects, and has not been proven to prevent heart attacks or strokes in people who have no evidence of cardiovascular disease (CVD). Chronic aspirin use may cause side effects such as gastrointestinal (GI) bleeding. (And people with diabetes are more likely to experience dangerous bleeding episodes, even if they are not taking aspirin.)
Don't begin taking aspirin until after you have talked with your physician. Here are the current aspirin therapy recommendations from the American Diabetes Association (ADA). Do you have:
- Diabetes and a history of CVD? Your doctor may prescribe 75 to 162 mg of aspirin daily in addition to primary CVD care.
- Diabetes and increased CVD risk? Ask your doctor if daily aspirin is an appropriate primary prevention therapy if you have type 1 or type 2 diabetes and are a man older than 50 or a woman older than 60 and have at least one more risk factor like high blood pressure, a family history of premature CVD and/or abnormal blood lipid levels.
- An allergy to aspirin? If you have CVD and an aspirin allergy, a daily dose of some other platelet-blocking drug, such as clopidogrel (Plavix), may be appropriate.
From our sister publication Diabetes Focus Spring 2013