Aspirin Can Lower Risk of Heart Disease in Some Diabetic Patients
More than 65 percent of total mortality from diabetes is due to cardiovascular disease, including fatal atherothrombotic events such as acute myocardial infarction (heart attack), ischemic stroke (due to reduced blood flow and oxygen levels), critical ischemia of lower limbs, and sudden heart failure.
Compared to individuals with a normal concentration of blood glucose, the presence of diabetes is known to confer a two to four times higher risk of vascular complications that may be partly due to the prothrombotic milieu observed in patients with diabetes.
A growing number of studies have confirmed that diabetes causes heart disease and that people with diabetes are more likely to suffer from heart disease than healthy individuals.
Over time, patients with diabetes will suffer damage to their heart and nerves due to their high blood sugar factor. People with diabetes are also more likely to have other diseases that increase the risk of heart disease. If a person with diabetes also has high blood pressure, the risk of heart disease is greatly increased. Excess LDL (“bad”) cholesterol in the blood of diabetics can form plaque in their damaged artery walls, eventually leading to atherosclerosis.
In 2021, Dr. Vikram Thakur, of the Texas Tech University Health Sciences Center, stated: “Diabetes is a major risk factor for cardiovascular disease. Short-term exposure to high blood sugar will directly affect the normal function of heart cells.”
A 2009 analysis of a study in the United Kingdom involving 45,108 patients found that, among people with no previous cardiovascular disease, those with diabetes had a significantly higher risk of developing cardiovascular disease than those without diabetes. Using meta-analysis to analyze the populations of various age groups, the study found that, compared with diabetic patients without a history of myocardial infarction, patients without diabetes with a history of myocardial infarction had a significantly increased risk of total coronary heart disease events by 43 percent. This means that in diabetic patients without existing cardiovascular disease, regular follow-up for early symptoms of cardiovascular conditions, myocardial infarction, and stroke is still essential.
Can Aspirin Reduce Risk of Heart Disease in Diabetics?
Aspirin is a salicylic acid derivative that acts as an antipyretic (fever reducer) and analgesic. It is primarily used to treat mild to moderate pain (e.g. toothache, headache, neuralgia, muscle aches) and diseases such as the common cold, flu, and rheumatic pain. Aspirin inhibits platelet aggregation and is used to prevent transient ischemic attacks and prevent thrombosis after venous fistulas or other surgical procedures, and is prescribed to prosthetic heart valve patients. It is also useful in the early treatment of cardiovascular diseases like angina pectoris as well as myocardial infarction.
In 2009, academics from the University of Oxford, UK, published a survey on the use of aspirin to prevent disease, which included 3,818 diabetic patients with no history of cardiovascular events. The incidence of extracranial hemorrhage and cardiac ischemia was significantly lower in these diabetic patients taking aspirin. This may indicate that aspirin is beneficial in the prevention of cardiovascular disease in some diabetic patients.
Aspirin, the cornerstone of treatment for patients with cardiovascular disease regardless of diabetes status, is associated with a 19 percent annual risk reduction of serious vascular events compared with a placebo over long-term follow-up. Notably, in primary prevention trials, aspirin significantly reduced serious vascular events by 12 percent regardless of diabetes status, corresponding to a small absolute risk reduction of vascular events per year.
From these studies, we can conclude that aspirin is beneficial for diabetics to take for the treatment or prevention of cardiovascular disease. So, if aspirin is so effective, why are diabetologists and cardiovascular disease specialists so cautious about prescribing it?
Aspirin Not Suitable for All Diabetic Patients
For people with Type 2 diabetes and a history of heart failure, taking aspirin daily appears to reduce the risk of dying from heart disease or being hospitalized for heart failure, according to a 2019 report from the American College of Cardiology (ACC) and the American Heart Association (AHA).
The study analyzed data from more than 12,000 people over the age of 55 with Type 2 diabetes and a history of heart failure, half of them took aspirin daily, while the other half did not. After five years of follow-up, the researchers found that patients taking aspirin had a 10 percent reduction in all-cause mortality and hospital admissions for heart failure. But, to their surprise, these patients taking aspirin daily experienced a 50 percent increase in nonfatal heart attacks and strokes.
Why was this the result? Diabetes and heart failure may lead to changes in the blood that make blood clots more likely to form, and aspirin reduces platelet aggregation, which reduces the chance of harmful blood clots that can cause heart disease and stroke. But the researchers expressed surprise at the increase in non-fatal heart attacks and strokes; the study’s lead author, Dr. Charbel Abi Khalil, stated that this may be partly because these patients were older, with an average age of 70, increasing their risk of cardiovascular events. Therefore, Khalil believes that patients with diabetes need to consult with their doctors to assess the risks and benefits of taking aspirin, according to their individual circumstances.
How to Choose the Right Dose of Aspirin
According to the 2019 guidelines on diabetes and cardiovascular disease jointly approved by the European Society of Cardiology (ESC) and the European Association for the Study of Diabetes (EASD), low doses of aspirin (75 to 100 mg/day) can be given to patients at high cardiovascular risk unless there are contraindications. Patients at risk for gastrointestinal bleeding should also be treated with drugs that inhibit gastric acid secretion, as recommended. People at high risk for cardiovascular disease include those with three or more cardiovascular risk factors, such as diagnosed cardiovascular disease, target organ damage, or diabetes. Patients may also be classified as high-risk if carotid or femoral plaque is detected, and these patients may also benefit from aspirin therapy.
In addition, aspirin (75 to 162 mg) may be taken daily by diabetic patients who are not at high risk for bleeding and who do not have cardiovascular risk factors. Cardiovascular risk factors include a history of vascular disease, hypertension, dyslipidemia (lipid imbalance), smoking habits, chronic renal failure, or proteinuria (protein in urine).
Which Diabetics Benefit From Taking Aspirin, and Which Don’t?
Scientists have found that patients with diabetes with different courses and complications have varying risks of vascular disease, and their antithrombotic treatment can be complicated, and it is, therefore, difficult for prevention guidelines to make specific recommendations.
In 2021, the European Heart Journal published an article summarizing the latest research on antithrombotic therapy in diabetic patients, which points out that not all people with diabetes should take aspirin, and that primary preventive use of aspirin in patients with diabetes “may only be considered in higher-risk individuals.”
Guidelines from the European Society of Cardiology recommend that patients with diabetes that use aspirin as a preventive measure against cardiovascular disease must meet one of the following conditions: damage to at least one target organ and/or three major risk factors; any disease duration for 10 or more years without risk factors for organ damage; and no contraindications for aspirin. These people can take aspirin to prevent heart disease.
In general, guidelines recommend aspirin monotherapy for diabetes patients with other risk factors and/or an estimated annual risk of vascular events of ≥1 percent. Therefore, aspirin should be avoided as a primary prevention strategy in diabetic patients at low or moderate cardiovascular risk, as the side effect of bleeding may outweigh aspirin’s potential benefit of reducing ischemic events.
High bleeding risk is a primary reason for not recommending aspirin, especially if the patient is aged 70 or older, or has a previous history of gastrointestinal bleeding, peptic ulcer disease, bleeding from other sites, anemia, thrombocytopenia, coagulation disorders, or chronic kidney disease, or is using other medications that increase the risk of bleeding, such as NSAIDs and steroids.
Notably, the benefit-risk ratio of aspirin in primary prevention for patients 70 and older was tested in a dedicated trial. After a median of 4.7 years of follow-up, the study demonstrated a significant 25 percent increase in the risk of major bleeding with aspirin use.
4 Ways to Prevent Heart Disease in Diabetic Patients
Controlling diabetes can be difficult. Having diabetes means you need to check your blood sugar levels frequently, choose healthy foods, stay active, remember to take your medicine, and make other beneficial decisions about your health. Here are four tips to help you cope with diabetes and reduce the risk of heart disease:
1.) Check your blood frequently with an A1C test, which reflects a three-month average blood sugar level. It is very important to maintain an A1C level in the stable and normal range (<6>
2.) Manage your blood pressure range. The normal range of blood pressure can vary according to age and health conditions, so consult your doctor if you do not know the normal range for you specifically. Maintaining healthy blood pressure is essential to prevent heart disease.
3.) Maintain blood cholesterol levels. A healthy diet to maintain a normal weight, regular aerobic exercise, and no alcohol intake can help you control your blood cholesterol.
4.) Stop smoking or don’t start. Smoking is the most common preventable cause of heart disease. Quitting smoking can lower or reduce the risk of a heart attack.
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