Diabetes is no longer a specific indication for prophylactic aspirin

Bottom line Based on recent research casting doubt on its benefit, the rules for aspirin use in patients with diabetes are now no different than for patients without diabetes: Men older than 50 years and women older than 60 years with at least one additional risk factor for cardiovascular disease (and that risk factor is not diabetes) should receive aspirin to prevent cardiovascular disease. (Level of evidence = 1a–)

Synopsis Several new trials have studied the prophylactic effect of aspirin specifically in patients with diabetes. Based on the results of several meta-analyses, the American Diabetes Association, American Heart Association, and American College of Cardiology have dialed back their recommendations regarding the use of aspirin for primary prevention in patients with diabetes. Based on a weighing of risks and benefits, the groups recommend low-dose daily aspirin (75-162 mg) in men older than 50 years and women older than 60 years who have at least one additional risk factor, as long as this risk factor is not diabetes. They do not recommend using aspirin in patients younger than these ages, including patients at increased risk, though they hedge and say that it “might be considered.” In other words, diabetes is not a significant risk factor for cardiovascular disease, which has been borne out in research (Diabet Med. 2009;26[2]:142-148.). This change puts these recommendations slightly at odds with those of the US Preventive Services Task Force Guidelines, which include diabetes as a risk factor for determining aspirin use in younger patients (http://www.ahrq.gov/clinic/uspstf/uspsasmi.htm), and are more conservative than the United Kingdom's NICE guidelines (http://www.nice.org.uk/nicemedia/live/11983/40803/40803.pdf).

Pignone M, Alberts MJ, Colwell JA, et al; American Diabetes Association; American Heart Association; American College of Cardiology Foundation. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Diabetes Care. 2010;33(6):1395-1402.