Aspirin Therapy in Diabetes

Colwell, John A.

doi:10.2337/diacare.20.11.1767

Cited by 258 publications

(132 citation statements)

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“…Moreover, from the US Physicians' Health Study and the HOT (Hypertension Optimal Treatment) trial we learned that aspirin treatment might even be more beneficial in diabetic patients than in high-risk non-diabetic subjects [83,88]. Thus, it has been advocated to prescribe aspirin for diabetic patients who are at a high risk of cardiovascular events, even those without any manifest cardiovascular abnormalities [84,85,89]. Recommendations of the American Diabetes Association, based on the meta-analysis of all primary and secondary prevention trials with use of aspirin, support the view that aspirin therapy should be prescribed as a secondary prevention strategy in diabetic men and women with evidence of large vessel disease and as a primary prevention strategy in high-risk men and women with DM, at the age > 30 years [81,82].…”

Section: Antiplatelet Drugs: Results From Clinical Trialsmentioning

confidence: 99%

Platelet activation in type 2 diabetes mellitus

Ferroni¹,

Basili

Falco

et al. 2004

Journal of Thrombosis and Haemostasis

395

288

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The abnormal metabolic state that accompanies diabetes renders arteries susceptible to atherosclerosis, being capable of altering the functional properties of multiple cell types, including endothelium and platelets. In particular, an altered platelet metabolism and changes in intraplatelet signaling pathways may contribute to the pathogenesis of atherothrombotic complications of diabetes. A variety of mechanisms may be responsible for enhanced platelet aggregation. Among them, hyperglycemia may represent a causal factor for in vivo platelet activation, and may be responsible for nonenzymatic glycation of platelet glycoproteins, causing changes in their structure and conformation, as well as alterations of membrane lipid dynamics. Furthermore, hyperglycemia-induced oxidative stress is responsible for enhanced peroxidation of arachidonic acid to form biologically active isoprostanes, which represents an important biochemical link between impaired glycemic control and persistent platelet activation. Finally, increased oxidative stress is responsible for activation of transcription factors and expression of redox-sensitive genes leading to a phenotypic switch of endothelium toward an adhesive, prothrombotic condition, initial platelet activation, adhesion and subsequent platelet aggregate formation. All this evidence is strengthened by the results of clinical trials documenting the beneficial effects of metabolic control on platelet function, and by the finding that aspirin treatment may even be more beneficial in diabetic than in high-risk non-diabetic patients. Attention to appropriate medical management of diabetic patients will have great impact on long-term outcome in this high-risk population. © 2004 International Society on Thrombosis and Haemostasis

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Section: Antiplatelet Drugs: Results From Clinical Trialsmentioning

confidence: 99%

Platelet activation in type 2 diabetes mellitus

Ferroni¹,

Basili

Falco

et al. 2004

Journal of Thrombosis and Haemostasis

395

288

View full text Add to dashboard Cite

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“…Among the recommendations for persons with diabetes is the use of low-dose aspirin (14), yet in the Look AHEAD study population nearly 50% of most ethnic groups reported never using aspirin. Over 80% of each ethnic group were taking anti-diabetic drugs, and approximately 40% were taking more than one.…”

Section: Discussionmentioning

confidence: 99%

Baseline characteristics of the randomised cohort from the Look AHEAD (Action for Health in Diabetes) study

Bray

2006

Diabetes and Vascular Disease Research

148

129

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OBJECTIVE-Look AHEAD (Action for Health in Diabetes) Study is a 16-center randomized clinical trial in overweight and obese individuals with type 2 diabetes designed to evaluate the longterm effects (up to 11.5 years) of an intensive weight loss intervention on the time to incidence for major cardiovascular events.RESEARCH DESIGN AND METHODS-Eligibility requirements are diagnosis of type 2 diabetes (determined by self-report and verification) in individuals age 45-74 years, BMI >25 kg/ m 2 (>27 kg/m 2 if currently taking insulin). The intensive lifestyle intervention is designed to achieve and maintain weight loss through decreased caloric intake and increased physical activity. The study is designed to provide 90% probability of detecting an 18% difference in major cardiovascular disease event rates in patients randomized to the intensive lifestyle intervention compared to the control group receiving standard diabetes support and education. RESULTS-The 5145 participants who were randomized between 2001 and 2004 were 63.3 % white, 15.6% African-American, 13.2% Hispanic, 5.1% American Indian, and 1.0% AsianAmerican, which closely paralleled the ethnic distribution of diabetes in the NHANES 1999-2000 survey. Their average age at entry was 59 ± 6.8 years (mean ± SD), and 60% were women. There were 31.5% between 45-54 years of age, 51.5% were 55-64, and 17.0% ≥65 years of age. There were 14.6% of participants who were taking insulin at the time of randomization and 14.1 % had a history of cardiovascular disease. More men (21.2%) than women (9.3%) had a history of cardiovascular disease. Few participants (4.4%) were current cigarette smokers compared to 16.2% in the NHANES 1999-2000 survey. Furthermore, 65% of participants had a first-degree relative with diabetes. Overall, BMI averaged 36 ± 5.9 kg/m 2 at baseline with 83.6% of the men and 86.0% of women having a BMI >30 kg/m 2 and 17.9% of men and 25.4% of women having a BMI > 40 kg/ m 2 . CONCLUSIONS-TheLook AHEAD study has successfully randomized a large cohort of participants who have type 2 diabetes with a wide distribution of age, obesity, ethnicity and racial background. IntroductionLook AHEAD is a randomized clinical trial being conducted in 16 centers in the U.S. The purpose of the Look AHEAD trial is to determine whether cardiovascular morbidity and mortality in persons with type 2 diabetes can be reduced through an intensive lifestyle intervention aimed at producing and maintaining weight loss. Briefly the intensive lifestyle intervention includes moderate-intensity physical activity to achieve and sustain at least 200 min per week of exercise together with a healthy diet that includes portion-controlled foods (3). The goal of this intervention is for individuals to achieve and maintain at least 10% loss Address Correspondence to: Mark Espeland, PhD, Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, 27157. NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript o...

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“…Many children with diabetes possess these risk factors. Use of aspirin has not been studied in diabetic individuals under 30 years of age and, in the absence of further studies, aspirin should not be recommended for those under the age of 21 years because of the increased risk of Reye's syndrome [81]. In this age group the benefits of aspirin may also be outweighed by the risk of gastric bleeding.…”

Section: Atherosclerosis Is Earlier and More Severe In Type 1 Diabetesmentioning

confidence: 99%

“…In a meta-analysis of 55,580 randomised participants (11,466 women), aspirin treatment was associated with a statistically significant 32% reduction in the risk of a first myocardial infarction and a 15% reduction in all important vascular events, but did not have any significant effects on non-fatal stroke or vascular death [80]. A position statement by the ADA recommended aspirin therapy for primary prevention in diabetic individuals with the following risk factors: a family history of CHD, smoking, hypertension, obesity, microalbuminuria and dyslipidaemia [81]. Many children with diabetes possess these risk factors.…”

Section: Atherosclerosis Is Earlier and More Severe In Type 1 Diabetesmentioning

confidence: 99%

Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment?

2005

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Autopsy studies have shown that atherosclerosis begins in adolescence in otherwise healthy individuals, and imaging techniques have shown that atherosclerosis develops earlier and is more prevalent in children with diabetes than in age-matched healthy controls. Cardiovascular disease has now overtaken diabetic nephropathy as the leading cause of premature mortality in young adults with diabetes, and the emphasis on disease prevention has accordingly shifted to a younger age group. The majority of children and adolescents with diabetes have suboptimal blood glucose control, and this contributes to accelerated arterial disease in this age group. Other conventional risk factors for coronary heart disease also need to be considered and treated aggressively. Effective early prevention of cardiovascular disease will involve lifestyle modification and full implementation of existing treatment guidelines, and largescale prospective studies will be needed to establish the risks and benefits of early pharmacological intervention in children and adolescents.

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Aspirin Therapy in Diabetes

Cited by 258 publications

References 0 publications

Platelet activation in type 2 diabetes mellitus

Platelet activation in type 2 diabetes mellitus

Baseline characteristics of the randomised cohort from the Look AHEAD (Action for Health in Diabetes) study

Atherosclerosis in childhood and adolescent type 1 diabetes: early disease, early treatment?

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