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Daily aspirin not recommended for diabetics younger than 50

Nevertheless, physicians should continue suggesting aspirin for heart attack and stroke survivors regardless of patient age, three medical organizations say.

By Christine S. Moyer — Posted June 15, 2010

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Diabetics should begin taking daily aspirin later in life than originally recommended to prevent a first myocardial infarction or a stroke, according to three organizations.

The American College of Cardiology Foundation, American Diabetes Assn. and American Heart Assn. recommend that physicians prescribe low-dose aspirin therapy (75 mg/day to 162 mg/day) to diabetic men older than 50 and diabetic women older than 60 who are at increased risk for cardiovascular disease. Risk factors include a family history of the disease, smoking, hypertension, albuminuria and dyslipidemia.

The guidelines were published online in May in the Journal of the American College of Cardiology, Diabetes Care, and Circulation: Journal of the American Heart Assn. (link).

The revisions are a shift from a recommendation issued in 2007 by the ADA and AHA that diabetics older than 40 take low-dose aspirin.

The new guidelines also differ from those issued by the U.S. Preventive Services Task Force in March 2009 that encouraged aspirin use in all men age 45 to 79 and in all women age 55 to 79 (link). The Food and Drug Administration has not approved daily aspirin for the prevention of heart disease due, in part, to risks of gastrointestinal and intracranial bleeding.

But physicians should continue recommending that heart attack and stroke survivors take aspirin every day, regardless of their age, according to the ACC Foundation, ADA and AHA. Doctors also should consider ending daily aspirin treatment for diabetics who do not meet the organizations' new guidelines, primarily men who are younger than 50 and women younger than 60, said Craig Williams, PharmD, who co-authored the guidelines.

"Doctors can tell patients, 'We now think you don't benefit from daily aspirin. We know there's a small risk' " of bleeding, said Williams, associate professor in the College of Pharmacy at Oregon Health & Science University/Oregon State University.

In 2009, a panel of experts selected by the ADA, AHA and ACC Foundation reviewed nine trials on the preventive effect of aspirin on cardiovascular events. The studies' findings were used to create the new guidelines.

Overall, the results suggest that aspirin reduces the risk of cardiovascular events by about 10%, Williams said. Among younger diabetics, who have less chance of heart disease, the risks outweighed the drug's potential benefits, he said.

In 2007, more than 23 million Americans -- 7.8% of the population -- had diabetes, according to the Centers for Disease Control and Prevention. In 2004, coronary heart disease was listed on 68% of death certificates for diabetics age 65 and older. The same year, stroke was noted on 16% of diabetics' death certificates.

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