01/11/2008
Should you be taking Aspirn?
Dr Edward Leatham
A news item in the Daily Mail in 17th Oct 2008 caught the attention of many of our patients:
“Around 2.3million Britons have type 2 diabetes, which is closely linked with growing levels of obesity, and they are up to five times more at risk of heart disease than the general population.
A study led by Professor Belch, published online in the British Medical Journal, involved 1,276 patients aged over 40 with diabetes and evidence of artery disease, who had not suffered a previous heart attack.
It found after eight years that there was no overall benefit from either aspirin or antioxidant treatment in preventing heart attacks or death. Patients in the aspirin groups had 116 heart attacks compared with 117 in those given placebos.
Professor Belch said there was widespread prescribing of aspirin in diabetes despite the lack of evidence to support its use. But studies show it can double the risk of stomach bleeding from an ulcer.
Routine use of the drug fails to prevent victims of type 2 diabetes suffering a first cardiac arrest, their research suggests.”
SCVC comment
We reviewed this BMJ original electronic publication in our local Journal Club with Consultant Diabetes specialists based at the Cedar Centre at The Royal Surrey County Hospital and have a consensus view that only patients with diabetes AND other risk factors such as established vascular disease OR high coronary calcium scores should take junior aspirin each day .
The study only recruited diabetic patients who were considered to be low risk- thus any patient whose physician was concerned may have heart disease was excluded. It is very hard to show statistical significant benefits of clinically proven and effective treatments in low risk patients so still advises patients in high risk groups to take junior aspirin unless told to stop it by their GP/Physician
We do not usually recommend Aspirin in apparently healthy middle aged people unless there is a high coronary calcium score indicating higher than standard risk of cardiovascular events