DOCTOR'S VIEW ARCHIVE
Medical Author: Ruchi
Medical Editor: William C. Shiel Jr., MD, FACP, FACR
A patient came into my office a few months ago with newly diagnosed diabetes. We had decided to manage her diabetes with a trial of diet and exercise. She was very compliant and was trying desperately to change her lifestyle to avoid being on medication. She started walking regularly and was reading every label on every item of food she bought. Her enthusiasm to control her disease was remarkable and very successful. At age 62, she had managed to change her lifestyle completely around. I saw this patient in follow-up last week and told her how very impressed I was with her progress. She had managed to control her diabetes with diet and exercise and did not need medication to control her blood sugar at this time. Her blood pressure was under control and her cholesterol levels were well within the normal range. She was thrilled.
As we concluded our visit, I handed her a prescription. She took it with a frown and said: " I thought you said I didn't need any medication. You know how much I despise the thought of taking pills. What's this all about?" The prescription I wrote was for coated aspirin. It had nothing to do with her blood sugar control - well not directly.
People with diabetes have a two to four fold increase in the risk for dying from heart disease. A major contributor to this risk is an increased production of thromboxane, a substance which causes vessels to constrict and also causes platelets (the cells that are responsible for clotting) to stick together and form clots inside of arteries. Aspirin blocks the production of thromboxane. Many large trials have shown a benefit of aspirin therapy in men and women after a heart attack (secondary prevention trials). In patients who had never had heart disease, those who started on aspirin had a 44% risk reduction in heart attacks. When diabetic patients were analyzed specifically, the rate of heart attack was 10.1% in the untreated group as compared to 4.0% in the group on aspirin. Based on this data, the American Diabetes Association has come out with guidelines for aspirin use in diabetes.
Aspirin should be used in any diabetic patient who has evidence of heart disease, a
prior heart attack, previous bypass procedures, a stroke, angina,
claudication, or blood vessel disease.
- Aspirin therapy should be considered in high-risk men and women with type 1 or type 2 diabetes. This includes diabetic patients with the following:
I explained to my patient that since she was over age 30 and had no contraindications, such as aspirin sensitivity, stomach ulcers or bleeding, or liver disease, she would benefit from aspirin therapy. I also mentioned that even though she had done a wonderful job with her lifestyle changes, there are certain risks inherent in diabetes even though blood sugar levels are well controlled. Although somewhat resistant, she seemed to understand that just like a vitamin a day, aspirin therapy is a preventative measure in patients with diabetes. In fact, she seemed much more enthusiastic about the idea when I told her that aspirin reduced her chance of heart attack by 25 to 30%.
As a specialist, I am surprised at how aspirin therapy is extremely underused. It's a simple therapy and a dose of baby aspirin, coated aspirin, or regular aspirin work equally well. As the guidelines show, blood sugar control is not a criterion for deciding which diabetics should be on aspirin. Next time you see your primary care physician, bring up the issue of aspirin therapy and any questions you may have. If there are no contraindications, the benefits of aspirin therapy far outweigh the risks.
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