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Independents' Day

Aspirin offers no heart benefits in diabetes patients

By Emma Wilkinson

A major new study has cast doubt on national guidelines recommending daily aspirin for primary prevention of cardiovascular events, after finding no benefit in patients with diabetes.

The research, published in the latest issue of JAMA, comes less than a month after Scottish researchers also found no benefit in diabetes for prevention of heart attacks and strokes.

The studies have led to increasing calls for NICE to look again and its guidance on use of aspirin and restrict it to patients with symptomatic cardiovascular disease.

In the latest study, Japanese researchers randomised 2,500 patients with diabetes but no history of atherosclerosis to low-dose aspirin or not.

After four years there was a non-significant 20% reduction in atherosclerotic events in the aspirin group, which didn't appear to justify the raised risk of adverse effects.

A total of 34 patients in the aspirin group and 38 patients in the non-aspirin group died from any cause.

GI bleeding occurred in 12 patients on aspirin and four in the non-aspirin group and retinal haemorrhage in eight patients on aspirin and four in the non-aspirin group.

An accompanying editorial said the recommendation by bodies such as NICE to use aspirin for primary prevention in patients with diabetes was based on ‘sparce' data.

Dr Antonio Nicolucci, author of the editorial and head of the department of clinical pharmacology and epidemiology at Consorzio Mario Negri Sud, Italy, said: ‘Recommendations seem based mainly on extrapolations from data from other high-risk groups, rather than on solid data derived from studies conducted specifically in patients with diabetes.'

Under diabetes guidelines published earlier this year, NICE recommends prophylactic aspirin treatment for older patients without hypertension and those under 50 years with another significant cardiovascular risk factor.

But Dr Rubin Minhas, a GP in Gillingham, Kent and cardiology lead for Medway PCT said the idea aspirin should be used for primary prevention had always been ‘wishful thinking'.

‘The recent demise of the metabolic syndrome and these aspirin results highlight how easy it is to get carried away with more ills for every pill.'

A NICE spokesperson said the institute had not had the opportunity to consider the implications of the research yet, but would ‘in due course'.

‘They will be considered in due course as part of our process for considering the potential for new evidence to impact on our guidance.'

Aspirin in diabetes: current NICE advice

- Offer low-dose aspirin (75 mg daily) to patients aged 50 years old or over if their blood pressure is below 145/90 mmHg
- Higher doses (75 mg daily) for patients under 50 years with significant other cardiovascular risk factors, such as features of the metabolic syndrome, strong early family history of cardiovascular disease, smoking, hypertension, extant cardiovascular disease, microalbuminuria
- Clopidogrel should be used in patients with aspirin intolerance

Aspirin - call for NICE to review guidelines after research finds it offers no CV benefits in type 2 diabetes patients Aspirin - call for NICE to review guidelines after research finds it offers no CV benefits in type 2 diabetes patients

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