Low-dose Acetylsalicylic Acid ( Aspirin ) therapy is a reasonable measure to prevent a first myocardial infarction or stroke among people with diabetes who also have a high risk for heart disease, according to a joint statement of the American Heart Association ( AHA ), the American Diabetes Association ( ADA ) and American College of Cardiology ( ACC ) Foundation.
People with diabetes eligible for low-dose Acetylsalicylic Acid therapy based on this guideline include most men over age 50 and most women over age 60 who have additional risk factors.

Trials to determine whether Acetylsalicylic Acid can prevent a first myocardial infarction or stroke in adults with diabetes have had mixed results, but overall suggest that Acetylsalicylic Acid modestly reduces the risk of cardiovascular events.
More research is needed to better define the specific effects of Acetylsalicylic Acid in patients with diabetes, including gender-specific differences, according to the joint statement.

Authors of the statement said scientific evidence to support Acetylsalicylic Acid therapy depends on the underlying cardiovascular risk. Those with higher risk should have greater benefit, they said, but the decision to use Acetylsalicylic Acid therapy depends on the use of other treatments such as cholesterol-lowering medicines, blood pressure control and quitting smoking.

On average people with diabetes are at three times the increased risk of cardiovascular events compared with age- and sex-matched people without diabetes, according to the Centers for Disease Control and Prevention ( CDC ). In patients with diabetes who are older than 65, 68 percent die from coronary heart disease and 16 percent from stroke. Researchers have proposed numerous mechanisms for the increased cardiovascular risk with diabetes, including increased tendency toward clot formation, platelet activity and damage to the arterial wall lining.

In 2007, the American Diabetes Association and Ameruican Heart Association jointly recommended that Acetylsalicylic Acid therapy ( 75–162 mg/day ) be started for both men and women above age 40 with another major risk factor, such as a family history of CVD, high blood pressure, smoking, high cholesterol or protein in the urine.

The major adverse effects of Acetylsalicylic Acid therapy include intracranial bleeding, which can lead to hemorrhagic stroke, and gastrointestinal bleeding. Based on data from primary and secondary prevention trials conducted in patients with and without diabetes, low-dose Acetylsalicylic Acid appears to be associated with an absolute risk of hemorrhagic stroke of one per 10,000 people annually.

Source: American College of Cardiology, 2010

XagenaMedicine2010


Link: Xapedia - Medical Encyclopedia