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Doubt over aspirin use for heart disease in diabetics

New research has cast doubt on the use of aspirin for the primary prevention of cardiovascular disease in patients with diabetes. The researchers claim the risks associated with aspirin use may outweigh any benefits in diabetics.

There was only a 'non-significant' 10 per cent reduction in the risk of cardiovascular death, stroke or myocardial infarction among diabetics taking 100mg aspirin daily. This compared with a 40 per cent reduction in non-diabetics who had at least one other risk factor for cardiovascular disease.

The Italian study, published in Diabetes Care (December), followed up [for an average of 3.7 years] nearly 5,000 patients, of whom 1,031 had diabetes but no previous cardiovascular event.

The researchers said the anti-platelet effects of aspirin may be 'overwhelmed' by aspirin-insensitive mechanisms of platelet activation and thrombus formation in diabetes.

The diabetes national service framework recommends GPs prescribe aspirin to diabetic patients at risk of cardiovascular disease. Diabetes UK has recommended all diabetes patients with a 10-year cardiac risk of 15 per cent or more who do not have uncontrolled hypertension should go on

aspirin for primary prevention of heart disease.

Dr Roger Gadsby, senior clinical lecturer at the University of Warwick and a member of the National Screening Committee's diabetes screening group, said use of aspirin for primary prevention in diabetes patients was 'controversial' and the results may sway some GPs not to prescribe it.

Dr Gadsby, a GP in Warwick, added: 'These are interesting results which cast some doubt on the value of aspirin, but there is no reason to take people off aspirin if they are

already taking it.'

Professor Mike Pringle, professor of general practice at the University of Nottingham and co-chair of the diabetes NSF delivery strategy group, said GPs should decide aspirin use on a case-by-case basis. 'Many diabetics also develop CHD. For them the usual preventive measures, including aspirin, should be used.

'But GPs should balance the side-effects ­ theoretical and experienced ­ against the possible benefits, which are probably low but may be worthwhile,' he said.

There is no case for GPs either offering aspirin to everyone without coronary heart diseases or persuading those taking aspirin to stop if they are happy on it.'

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