June 2, 2010 -- Women under 60 and men under 50 who have diabetes but no other major risk factors for heart disease probably should not be on low-dose aspirin therapy, new research suggests.
The new recommendations are based on close examination of nine studies that found the risks of some aspirin side effects, such as stomach bleeding, should be better balanced against the possible benefits of using aspirin.
The new guidelines suggest low-dose aspirin therapy be used by men over 50 and women over 60 with diabetes who have other risk factors for heart attack and stroke.
The U.S. Preventive Services Task Force still recommends low-dose aspirin for prevention of heart attacks and stroke in men aged 45 to 79 and women aged 55 to 79.
The new guidelines have been endorsed by a panel of experts from the American Diabetes Association, the American Heart Association, and the American College of Cardiology Foundation.
"The larger theme here is that use of low-dose aspirin to prevent heart attacks in people who have not already experienced one is probably not as efficacious as we used to believe it was," Craig Williams, PharmD, an associate professor in the College of Pharmacy at Oregon State University, says in a news release.
Williams, one of those on the recent review panel, says doctors need to balance the benefits of any medication against possible side effects, and that even low-dose baby aspirin has some degree of risk, even though it is very low.
"[We] have to be able to show clear benefits that outweigh that risk," he says. "In the case of young adults with diabetes but no other significant risk factors, it's not quite clear that the benefits are adequate to merit use of aspirin."
People with diabetes face a higher risk of heart disease as they age, and many doctors have recommended that diabetes patients use low-dose aspirin along with their other medications.
"The newest studies just weren't showing adequate benefits for some younger diabetics," Williams says.
Part of the issue is that widespread use of drugs to control blood pressure and reduce cholesterol has lessened the additional benefits of aspirin, Williams says.
Generic statin medications for cholesterol and various hypertension medications are available now at little cost and should be considered part of the optimal approach of treatment and prevention.
There is no evidence that higher doses of aspirin, over 75-162 milligrams per day, have added value in heart attack prevention, Williams says.
A baby aspirin, the 81-milligram variety, has achieved an adequate level of protection for diabetes patients with heart attack risk factors, the researchers write.
They also say that ongoing research should provide additional information on the role of low-dose aspirin for the prevention of cardiovascular events, specifically in people with diabetes.
The new advice is published as a position statement of the American Diabetes Association in the journal Diabetes Care.
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