Wednesday, November 30, 2011

Aspirin-to take or not to take is the question

Aspirin- to take or not to take is the question.

The value of taking aspirin to help prevent cardiovascular disease has been unclear for many years. Taking aspirin has been about risk. Is the slight reduction in risk of cardiovascular disease greater than the risk of bleeding from our intestine or having a hemorrhagic stroke
Aspirin has been shown to reduce cardiovascular mortality in high risk patients with a previous stroke or myocardial infarct. This is called (secondary prevention). Aspirins benefit for people without know cerebral vascular or heart disease is less clear.( primary prevention )
The American Diabetes Association (ADA) and the American Heart Association (AHA) in the past have recommended low dose aspirin as a PRIMARY PREVENTION strategy for people with diabetes who are at increased cardiovascular risk. This includes some one with diabetes over the age of 40 with additional risk factors such as increased BP,smoking history,albuminuria or dyslipidemia.
Large clinical trials with over 95000 participants found that aspirin reduced vascular events by 12%. interesting caveat were found also; there was minimal effect on reducing death from cardiovascular disease, Aspirin was more effective in reducing coronary events in men than women and women had more benefit in stroke prevention than men

Current 2010 ADA and AHA recommendations
“:low-dose aspirin (75 to 162 mg/day) aspirin use for primary prevention is reasonable for adults with diabetes and no previous history of vascular disease who are at increased risk of cardiovascular disease ( 10 year risk > 10%) and who are not at increased risk of bleeding. This generally includes most men over age 50 and women over age 60 who also have one of the following risk risk factors . 1) smoking 2) hypertension3) dyslipidemia 4) family history of premature vascular disease 5)albuminurea.”
” however ,aspirin is no longer recommened for those at low cardiovascular risk( women under age 60 and men under age 50 with no cardiovascular risk factors) as the benefit is likely out weighed by the risk of significant bleeding “.

My question is ; how do we know who is at low risk. My understanding of silent coronary heart disease is that it is silent and that our know risk factors and most test other than coronary artery ultra sound may miss the underlying disease. See page 48 in Diabetes Office Visit for more details. This type of information has made it difficult for me in making a specific recommendation regarding aspirin. During my 35 years of diabetes practice i have seen many people with myocardial infarcts and I cannot recall any one with a gastrointestinal bleeding from aspirin. My experience taught me to be very liberal with my aspirin recommendations.

How do you feel about aspirin use? more on aspirin tomorrow

Check out my video and see how Diabetes office visit App. could help you reduce your risk of cardiovascular disease .

Dr. Calder

Dr. Calder

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Your comments and questions are appreciated. David Calder,MD