ABSTRACT
BACKGROUND
The American Heart Association Guidelines recommend aspirin for all apparently healthy individuals whose 10-year risk of a first coronary heart disease (CHD) event is >10%.
METHODS
The United States (US) Preventive Services Task Force (USPSTF) has recently updated its guidelines to encourage men 45 to 79 years and women 55 to 79 years to use aspirin when the potential benefit outweighs the potential harm. In addition, in some US guidelines, diabetes is considered to be a CHD risk equivalent.
RESULTS
Two recently published trials, the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) and the Prevention of Progression of Arterial Disease and Diabetes (POPADAD), concluded that aspirin did not reduce risks of CHD. Both JPAD and POPADAD had inadequate statistical power. Reliable randomized evidence is necessary to provide a sufficient totality of evidence about benefits and risks among diabetics.
CONCLUSION
At present, astute individual clinical judgments are necessary.
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ACKNOWLEDGEMENT
Dr. Hebert has no conflicts of interest to disclose.
Ms. Schneider is funded by the Charles E. Schmidt College of Biomedical Science, Department of Clinical Science and Medical Education and Center of Excellence at Florida Atlantic University (FAU) as Project Coordinator on two investigator-initiated research grants funded to FAU by Bayer testing the effects of aspirin dose on platelet biomarkers, inflammatory markers, nitric oxide formation, and endothelial function.
Dr. Hennekens is funded by the Charles E. Schmidt College of Biomedical Science, Department of Clinical Science and Medical Education and Center of Excellence at Florida Atlantic University (FAU) as Principal Investigator on two investigator-initiated research grants funded to FAU by Bayer testing the effects of aspirin dose on platelet biomarkers, inflammatory markers, nitric oxide formation and endothelial function.
Dr. Hennekens serves as an independent scientist in an advisory role to investigators and sponsors as a member of Data and Safety Monitoring Boards for ARRIVE, ASPREE and ASCEND.
Dr. Hennekens receives royalties for authorship or editorship of three textbooks and as co-inventor on patents concerning inflammatory markers and cardiovascular disease that are held by Brigham and Women’s Hospital.
Dr. Hennekens has an investment management relationship with SunTrust Bank who has sole discretionary investment authority.
Dr. Hebert wrote the initial draft of the manuscript, which was critically reviewed and revised by Dr. Hennekens. Wendy Schneider, MSN, researched the literature and assisted with revision and preparation of the manuscript.
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Hebert, P.R., Schneider, W.R. & Hennekens, C.H. Use of Aspirin Among Diabetics in the Primary Prevention of Cardiovascular Disease: Need For Reliable Randomized Evidence and Astute Clinical Judgment. J GEN INTERN MED 24, 1248–1250 (2009). https://doi.org/10.1007/s11606-009-1095-5
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DOI: https://doi.org/10.1007/s11606-009-1095-5