Diabetes Self-Management Blog

Should people who have diabetes — but no signs of cardiovascular disease — take aspirin to help reduce their risk of heart attack and stroke? Studies have shown that aspirin helps prevent additional heart attacks and strokes in people who have already had one. And since having diabetes puts people at an increased risk of having a heart attack or stroke, the American Heart Association recommends aspirin therapy. However, two studies published late last year have called this practice into question.

The first study, published in the journal BMJ in October 2008, enrolled 1,276 people in Scotland aged 40 and up. These people had Type 1 or Type 2 diabetes and no symptoms of cardiovascular disease. The participants were randomly assigned to take one of four combinations of pills: a low-dose (100 milligrams [mg]) tablet of aspirin plus an antioxidant capsule; the aspirin plus a placebo (inactive) capsule, a placebo tablet plus an antioxidant capsule; or a placebo tablet plus a placebo capsule. Neither the participants nor their doctors knew which treatment they were receiving.

After about six years, the researchers found no significant difference in rates of cardiovascular “events,” such as heart attack or stroke, in any of the groups. They concluded that neither aspirin nor antioxidants helped prevent cardiovascular events in the people with diabetes who were studied.

The second study was published on November 12, 2008, in The Journal of the American Medical Assocation. It took place in Japan and enrolled 2,539 people with Type 2 diabetes and no history of cardiovascular disease. Participants in this study were randomly assigned to take low-dose aspirin (either 81 mg or 100 mg) or no aspirin. There was no placebo group, and participants knew what kind of treatment they were receiving.

After about four years, the researchers found that rates of cardiovascular events in the aspirin and nonaspirin groups were not significantly different. They concluded that low-dose aspirin did not lower the risk of cardiovascular events in this group of people with Type 2 diabetes.

These studies do not call into question that aspirin is valuable as “secondary prevention” for people who have already had a heart attack, stroke, or conditions such as unstable angina (chest pain), or peripheral vascular disease.

Doctors commenting on the studies have suggested that individuals with diabetes should decide with their doctors whether aspirin therapy is right for them.

Do you take aspirin each day? Have you ever had a heart attack, stroke, or other cardiovascular event? Does this news make you question your therapy? Share your thoughts with a comment below.

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Comments
  1. Dear Tara.

    You wonder if it has any effect at the low dosages taken every day. I know that 3 tablets of 325 mg make my heart feel a lot better on occaision when it is unhappy. This is an unsustainable dosage on a daily basis because of tummy ulcers which I do get on occaision.

    My blood is very coaglulative so may be a bit every day could possibly be of some good. What would have been interesting to see is if eschemic strokes were less frequent in patients using aspirin vs those who had eschemic ones that were on placebo.

    You wonder if just using the general diabetic population dilutes the beneficial effect enough to make it statistically insignificant.

    Posted by CalgaryDiabetic |
  2. Beneficial effects of daily aspirin have long been shown to be dose-dependent. Any study of diabetics and aspirin that does not take aspirin resistance among diabetics into account as a variable will not be yielding much useful information. Yes, I take aspirin daily at the standard threshold pain-relief dose of 225mg, based on my own assessement of the incomplete information that’s out there.

    Posted by Michael.Massing |
  3. I’ve been prescribed the aspirin therapy at 81mg per day, but have no existing cardiovascular problems. I will certainly question my doc about the results of these studies. One thing you fail to address here is the negative consequences of aspirin therapy with no cardio/stroke issues present. Are there any?

    Posted by Lenny Gurvich |
  4. I was diagnosed with Type 2 diabetes in 1992, and I have had one heart attack, in 1994, but none since then. For several years I took an 81-mg aspirin daily, because of that heart attack, but after learning that aspirin can worsen ARMD (age-related macular degeneration) and tinnitus, both of which I have, I reduced my aspirin consumption to three per week as a compromise. Now I wonder if I should be taking it at all.

    Posted by Ricki |
  5. I also take 81mg aspirin daily, as well as other NSAIDs for arthritis. I am a type I diabetic, no cardiovascular events, but 2 parents who died of stroke and heart attack. Should I be taking the aspirin–and might it lead to ulcers in light of the other NSAIDs I take?

    Posted by Vicki Blakeman |
  6. Many of these studies in medicine seem to be so sloppily designed and checked that often the exact opposite results are obtained from two similar studies. Aspirin is well documented to ‘thin’ the blood and encourage bleeding. This should make it worthwhile for older people who might get heart attacks. It does upset my stomach but when I actually feel angina-type pains I take two regular 325 mg. aspirin and my pain goes away and does not come back (maybe months later) and I have never had a heart attack. I am 78 years old. I also take fish oil and vitamin E both of which are supposed to also ‘thin the blood’.

    Posted by rentie13l |
  7. Quadruple Bypass 4 years ago. 62 years. 2 Aspirins daily. I’m alive. A little late to question my daily use. I’m alive.

    Posted by Gunner |
  8. Dear Michael and Readers.

    I would think that 225 to 325 mg would do something to thin the blood but 81 mg useless?

    What about tummy ulcers at 325 mg each and every day?

    Posted by CalgaryDiabetic |
  9. Yes, I take aspirin (5gr) at hs every night -
    have been doing this for the past 15 years with no apparent problem - -

    I was playing golf (before taking aspirin) with a cardioligist (sp?) I was approx 65 yeaars old - in good shape - working 6 days a week - I just liked to work - keep busy….

    Retired now - feeling great - waiting to see what happens next

    Posted by sweetbob |
  10. My spouse and I, both 84, have been taking an 81mg aspirin for many years. Neither of us have experienced a
    heart attack or illnesses these aspirin reputedly prevent.

    Posted by lthompso |

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