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Does Aspirin Do Much Good?

Tara Dairman

January 16, 2009

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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