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Thursday, October 23, 2008

Doubts on the benefits of aspirin

Aspirin Does Not Prevent Heart Attacks in High-Risk Patients

DUNDEE, United Kingdom -- October 17, 2008 -- Taking regular aspirin and antioxidant supplements does not prevent heart attacks in high-risk groups with diabetes and asymptomatic arterial disease, according to a study published today in the online issue of the BMJ.

Although there is considerable evidence showing no protective benefit of aspirin in high-risk patients without heart disease, guidelines are inconsistent and aspirin is commonly prescribed for the primary prevention of heart disease in patients with diabetes and with peripheral arterial disease.

Jill Belch, University of Dundee, Dundee, United Kingdom, and colleagues investigated whether aspirin and antioxidants given together or separately can reduce heart attacks and death in patients with diabetes and arterial disease.

The study included 1,276 patients aged over 40 years with diabetes and evidence of artery disease. Patients were randomised to receive either aspirin or placebo, an antioxidant or placebo, aspirin and antioxidant, or double placebo. Patients were followed over 8 years.

Overall, the researchers found no benefit from either aspirin or antioxidant treatment in the prevention of heart attacks or death. Patients in the aspirin groups had 116 primary events compared with 117 in the placebo group. No significant difference in events was seen between the antioxidant group and the placebo group.

The authors concluded by voicing their concern at the widespread prescribing of aspirin despite the lack of evidence to support its use in the primary prevention of heart attacks and death in people with diabetes and in view of its possible side effects.

In an accompanying editorial, William Hiatt, Colorado Prevention Center, Denver, Colorado, said: "These findings show that unlike statins and drugs for reducing hypertension, which have a benefit in all risk groups including those with and without heart disease, only patients with a history of clinical or symptomatic heart disease or stroke disease benefit from taking aspirin."

SOURCE: University of Dundee

However, the latest American Diabetes Association recommendations continue to advocate aspirin.

Antiplatelet Agents
● Use aspirin therapy (75–162 mg/day)as a secondary prevention strategy in diabetic individuals with a history of CVD. (A)
● Use aspirin therapy (75–162 mg/day)as a primary prevention strategy in those with type 1 or type 2 diabetes at increased cardiovascular risk, including those who are 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria). (A)

Download the ADA 2008 recommendations on the treatment of diabetes. here.

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