Aspirin Use Among Adults With Diabetes: Estimates from the Third...
Objective: Since 1997, the American Diabetes Association has recommended that aspirin therapy be considered for adults with diabetes who have cardiovascular disease (CVD) or CVD risk factors. We examined the prevalence of regular aspirin use among adults in the U.S. with diagnosed diabetes.
Research Design and Methods: The Third National Health and Nutrition Examination Survey (1988-1994) used a probability sample of the U.S. population and included an interview, physical examination, and laboratory studies. Among the survey participants were 1,503 adults (age
21 years) with self-reported diabetes. We defined regular aspirin use as reported having taken aspirin
15 times in the previous month. CVD conditions were self-reported heart attack and stroke and symptoms of angina and claudication. CVD risk factors included smoking, hypertension, obesity, albuminuria, lipid abnormalities, and family history of heart attack.
Results: An estimated 27% of adults with diabetes had CVD, and an additional 71% had one or more CVD risk factors. Aspirin was used regularly by 37% of those with CVD and by 13% of those with risk factors only. Adjusted odds of regular aspirin use were significantly greater for individuals with CVD than for those with one CVD risk factor (odds ratio [OR] = 4.3); for non-Hispanic whites than for blacks, Mexican-Americans, and others (OR = 2.5); and for individuals age 40-59 years than for those <40 years (OR = 33.3).
Conclusions: Nearly every adult in the U.S. with diabetes has at least one risk factor for CVD and thus may be considered a potential candidate for aspirin therapy. During 1988-1994, only 20% (95% CI 16-23) took aspirin regularly. Major efforts are needed to increase aspirin use.
Aspirin therapy to prevent cardiovascular disease (CVD) may be particularly beneficial for people with diabetes. First, people with diabetes are two to four times as likely to develop CVD as people without diabetes. Second, people with diabetes have been observed to have altered platelet function with increased production of thromboxane, and the primary way in which aspirin reduces the risk of CVD is through its effects on platelet function resulting in reduced thromboxane synthesis.
Aspirin has been shown to be an effective and relatively safe treatment for people with diabetes. Trials have demonstrated that aspirin therapy can prevent the first heart attack, stroke, or other indication of CVD (primary prevention) and also subsequent cardiovascular events (secondary prevention) without any significant increase in retinal or vitreous hemorrhage, gastrointestinal bleeding, or hemorrhagic stroke.
The American Diabetes Association (ADA) published guidelines for aspirin therapy in adults with diabetes in 1997 and reissued them, with minor revisions, in 2000. The ADA recommends that, in the absence of specific contraindications, aspirin should 1) be used for secondary prevention by men and women with evidence of large vessel disease (myocardial infarction, vascular bypass procedure, stroke, transient ischemic attack, or angina) and 2) be considered for primary prevention in adults who have one or more risk factors for CVD (family history of coronary heart disease, smoking, hypertension, obesity, albuminuria, or lipid abnormalities) or who are
30 years of age. Doses of 81-325 mg/day of enteric-coated aspirin are advised. Specific contraindications cited by the ADA include aspirin allergy, bleeding tendency, anticoagulant therapy, recent gastrointestinal bleeding, and clinically active liver disease. The ADA notes that the use of aspirin has not been studied in individuals with diabetes who are <30 years of age and that aspirin should not be recommended for those <21 years because of the risk of Reye's syndrome.
In this report, we use the ADA guidelines and a nationally representative sample to estimate the percentage of adults with diabetes who are potential candidates for aspirin therapy and the prevalence of regular aspirin use among such individuals.
Objective: Since 1997, the American Diabetes Association has recommended that aspirin therapy be considered for adults with diabetes who have cardiovascular disease (CVD) or CVD risk factors. We examined the prevalence of regular aspirin use among adults in the U.S. with diagnosed diabetes.
Research Design and Methods: The Third National Health and Nutrition Examination Survey (1988-1994) used a probability sample of the U.S. population and included an interview, physical examination, and laboratory studies. Among the survey participants were 1,503 adults (age
21 years) with self-reported diabetes. We defined regular aspirin use as reported having taken aspirin
15 times in the previous month. CVD conditions were self-reported heart attack and stroke and symptoms of angina and claudication. CVD risk factors included smoking, hypertension, obesity, albuminuria, lipid abnormalities, and family history of heart attack.
Results: An estimated 27% of adults with diabetes had CVD, and an additional 71% had one or more CVD risk factors. Aspirin was used regularly by 37% of those with CVD and by 13% of those with risk factors only. Adjusted odds of regular aspirin use were significantly greater for individuals with CVD than for those with one CVD risk factor (odds ratio [OR] = 4.3); for non-Hispanic whites than for blacks, Mexican-Americans, and others (OR = 2.5); and for individuals age 40-59 years than for those <40 years (OR = 33.3).
Conclusions: Nearly every adult in the U.S. with diabetes has at least one risk factor for CVD and thus may be considered a potential candidate for aspirin therapy. During 1988-1994, only 20% (95% CI 16-23) took aspirin regularly. Major efforts are needed to increase aspirin use.
Aspirin therapy to prevent cardiovascular disease (CVD) may be particularly beneficial for people with diabetes. First, people with diabetes are two to four times as likely to develop CVD as people without diabetes. Second, people with diabetes have been observed to have altered platelet function with increased production of thromboxane, and the primary way in which aspirin reduces the risk of CVD is through its effects on platelet function resulting in reduced thromboxane synthesis.
Aspirin has been shown to be an effective and relatively safe treatment for people with diabetes. Trials have demonstrated that aspirin therapy can prevent the first heart attack, stroke, or other indication of CVD (primary prevention) and also subsequent cardiovascular events (secondary prevention) without any significant increase in retinal or vitreous hemorrhage, gastrointestinal bleeding, or hemorrhagic stroke.
The American Diabetes Association (ADA) published guidelines for aspirin therapy in adults with diabetes in 1997 and reissued them, with minor revisions, in 2000. The ADA recommends that, in the absence of specific contraindications, aspirin should 1) be used for secondary prevention by men and women with evidence of large vessel disease (myocardial infarction, vascular bypass procedure, stroke, transient ischemic attack, or angina) and 2) be considered for primary prevention in adults who have one or more risk factors for CVD (family history of coronary heart disease, smoking, hypertension, obesity, albuminuria, or lipid abnormalities) or who are
30 years of age. Doses of 81-325 mg/day of enteric-coated aspirin are advised. Specific contraindications cited by the ADA include aspirin allergy, bleeding tendency, anticoagulant therapy, recent gastrointestinal bleeding, and clinically active liver disease. The ADA notes that the use of aspirin has not been studied in individuals with diabetes who are <30 years of age and that aspirin should not be recommended for those <21 years because of the risk of Reye's syndrome.
In this report, we use the ADA guidelines and a nationally representative sample to estimate the percentage of adults with diabetes who are potential candidates for aspirin therapy and the prevalence of regular aspirin use among such individuals.