Should all diabetic patients be on aspirin for primary prevention?

Abstract

Not all patients with diabetes mellitus (DM) should be routinely prescribed daily aspirin (acetylsalicylic acid) for prevention regardless of their cardiovascular disease (CVD) risk. Aspirin is routinely prescribed for prevention of cardiovascular events that include nonfatal myocardial infarction (MI), unstable angina, ischemic stroke, transient ischemic attack (TIA) or cardiovascular death [1]. In general, the benefit of aspirin as primary prevention in patients who have a low-risk profile for cardiovascular events is questionable, particularly due to high risk of intracranial and gastrointestinal bleeding associated with aspirin use [2]. Given the increased risk for a cardiovascular event, the diabetic patient could benefit from aspirin therapy for primary prevention. However, the routine practice of aspirin for all diabetic patients has been controversial [2]. Nevertheless, administration of daily low-dose aspirin (81 mg) is well recognized in diabetics for secondary prevention [2,3].In 2015 thirty million Americans; 9.4% of the US population; with more than 1.5 million Americans are diagnosed with diabetes every year [4]. The incidence of diabetes is highest among American Indians/Alaskan Natives (15.1%) followed by African Americans (12.7%). Diabetes is associated with high cardiovascular morbidity and mortality that drives the cost of healthcare for diabetic patients to be 2.3 times higher than what cost would be for non-diabetic patients [4]. This lead to the emphasis on preventing cardiovascular events in diabetic patients by slowing atherosclerosis process using statin therapy, a healthy lifestyle and good glucose control.

In-Hospital Mortality and Its Predictors among Hospitalized Diabetes Patients: A Prospective Observational Study

“…Moreover, the finding of this study supplemented the study conducted in America, among COVID-19 patients with DM receiving statins in whom 12% reduction in the adjusted risk of in-hospital mortality was reported [ 33 ]. It also supported the ADA guidelines recommendation which promotes the use of low-dose aspirin for diabetic patients with 10-year CVD risk ≥10% [ 34 ]. Similarly, other studies also found that ACEIs reduced all-cause mortality, cardiovascular mortality, and cardiovascular events in patients with DM [ 35 , 36 ].…”