For many years, physicians have recommended a daily aspirin to certain patients who have or are at risk of cardiovascular disease. Diabetes significantly increases the risk of developing cardiovascular conditions such as heart attack and stroke. Research conducted since the early 1970s have consistently shown that taking a daily aspirin can improve blood flow to the heart and reduce the risk of coronary ailments.
The American Diabetes Association (ADA) recommends low-dose aspirin therapy for patients with diabetes who are at high risk for cardiovascular ailments. This includes patients who have had a previous cardiovascular condition or meet other risk criteria. However, some patients with diabetes should not take a daily aspirin, according to the ADA. These include people under age 21 and those who have any of the following conditions:
- Aspirin allergy
- Tendency to bleed
- Recent bleeding from the digestive tract
- Diabetic nephropathy (kidney disease)
- Active liver disease
- Uncontrolled high blood pressure
Any patient with diabetes considering daily aspirin therapy should first consult a physician. The physician will also suggest the appropriate dosage for a patient. This usually ranges between 75 and 325 milligrams daily.
Patients with aspirin sensitivities may use substitutes, such as antiplatelet medications, to obtain benefits similar to those provided by daily aspirin therapy.
About aspirin and diabetes
Some – but not all – patients with diabetes may benefit from taking aspirin daily. For more than 100 years, aspirin has been used as a pain reliever for headaches and other minor aches and pains. More recently, its role in the prevention and management of cardiovascular disease, the leading cause of premature death among patients with diabetes, has been widely studied. At least 65 percent of patients with diabetes will die from complications related to heart attack or stroke, according to the American Diabetes Association.
The precise reason why aspirin helps prevent cardiovascular disorders is unknown. Researchers believe that it helps keep red blood cells from clumping together, a condition that appears to be more prevalent among those with diabetes. When red blood cells cluster, they can form clots that narrow or block blood vessels and increase the risk of heart attack and stroke. Some patients with type 1 diabetes, type 2 diabetes or other forms of diabetes can benefit from daily aspirin therapy.
Aspirin also appears to have anti-inflammatory properties. By reducing inflammation, aspirin appears to inhibit the development of atherosclerosis. In addition, aspirin may be helpful in protecting people from blockages in the blood vessels of the brain, which can prevent strokes and mini-strokes (transient ischemic attacks). Scientists are studying whether inflammation plays a role in causing diabetes and whether salsalate, a nonsteroidal anti-inflammatory drug (NSAID) related to aspirin, may help treat type 2 diabetes and heart disease.
Recent research has found that aspirin therapy might have other benefits, including reduced risk of certain cancers, prostate enlargement (benign prostatic hyperplasia) and possibly asthma.
Aspirin therapy is not appropriate for everyone. For people taking certain antidiabetic agents to control type 2 diabetes, such as sulfonylureas, daily aspirin therapy may not be recommended. Aspirin may influence the effectiveness of diabetes medications. Patients with aspirin sensitivities may be advised by their physician to use substitutes, such as antiplatelet medications, to obtain benefits similar to those provided by daily aspirin therapy.
In addition, people with kidney or liver disease generally are not advised to begin daily aspirin therapy because of the potential damage that may be caused to these organs. Long-term use of painkillers, especially aspirin and acetaminophen at the same time, may damage the kidneys in people with diabetes. However, a single daily dose of aspirin to protect cardiovascular health is normally safe. Aspirin therapy is not advised for people under the age of 21 because of the risk of developing the rare but potentially serious Reye’s syndrome.
Many patients with diabetes can benefit from daily aspirin therapy, which helps reduce the risk of cardiovascular disease. The American Diabetes Association (ADA) makes the following recommendations regarding daily aspirin therapy:
- Primary prevention strategy. Aspirin is likely to benefit men and women with type 1 diabetes or type 2 diabetes with risk factors for cardiovascular health disorders, such as:
- Family history of coronary heart disease
- High blood pressure
- Age 30 or older
- The following lipid profile:
|Total cholesterol||> 200 mg/dL||> 200 mg/dL|
|LDL||> 100 mg/dL||> 100 mg/dL|
|HDL||< 45 mg/dL||< 55 mg/dL|
|Triglycerides||> 200 mg/d||> 200 mg/d|
- Secondary prevention strategy. Patients with diabetes who have some form of cardiovascular disease may help prevent a second occurrence with aspirin therapy. This includes those with a history of:
- Heart attack (myocardial infarction)
- Vascular bypass procedure
- Stroke or transient ischemic attack (mini-stroke)
- Peripheral vascular disease
- Claudication (pain or weakness in the legs during exercise)
- Angina (chest discomfort caused by inadequate blood flow through the blood vessels of the heart muscle)
The ADA recommends that patients use enteric-coated aspirin in daily dosages of between 81 and 325 milligrams, although dosages as low as 75 milligrams may also be beneficial. Enteric coating helps the pill pass through the stomach without dissolving, allowing the aspirin to be absorbed in the intestine and thus reducing side effects. Aspirin therapy is not recommended for patients with any of the following:
- Age of less than 21 years
- Aspirin allergy
- Bleeding tendency
- Anticoagulant (medication to prevent blood from clotting) use
- Recent gastrointestinal bleeding
- Clinically active liver disease
- Uncontrolled high blood pressure
Diseases of the kidneys such as diabetic nephropathy or end-stage renal failure also typically preclude the use of aspirin.
Individuals are advised to ask their physician about the risks and benefits of aspirin therapy. Even in people who do not have diabetic nephropathy, regular long-term use of painkillers such as aspirin can cause a permanent form of kidney damage called analgesic nephropathy that requires dialysis or a kidney transplant, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
General guidelines for use
Aspirin relieves pain and reduces the risk of cardiovascular disease. However, it can also cause bleeding in the stomach and other side effects. Following the recommendations for proper use of aspirin can help reduce the chance of these side effects occurring.
Aspirin should be taken with mild food or an antacid to reduce the chance of stomach irritation, unless it is coated to be gentler to the stomach (enteric coated). These coated tablets should not be chewed, crushed or broken, except in the case of emergency, such as during a heart attack. Some people’s gastrointestinal tracts cannot dissolve coated aspirin, and the medication will remain intact until it leaves the body in a bowel movement.
There are a number of side effects associated with aspirin use that have been reported by patients. These include:
- Stomach irritation, which could in time lead to ulcers, pain, heartburn, nausea, vomiting, internal bleeding or holes in the stomach or intestines
- Stomach damage, possibly indicated by bloody, black or tarry stools or by bloody vomit
- Facial swelling (usually indicates an allergy)
- Asthma attack (another indicator of allergy)
- Ringing in the ears (tinnitus), when taken in high doses
- Risk of bleeding in the brain, a medical emergency that could lead to stroke
Aspirin should never be taken in place of other medications or treatments recommended by a physician. Furthermore, people taking an anticoagulant (medication to prevent blood from clotting) should not take aspirin unless advised by a physician. This is because both medications increase the risk of bleeding.
People taking another nonsteroidal anti-inflammatory drug (NSAID) may also be discouraged from taking aspirin. If a physician recommends that a patient take a daily aspirin and another NSAID, the NSAID must be taken more than two hours after the aspirin or the aspirin will not be effective.
Finally, people should not take aspirin if they are pregnant, hypertensive, allergic to certain medications or about to undergo surgery, unless specifically recommended by their physician.
Recent research indicates that taking aspirin or other NSAIDs around the time of a vaccination may hinder the vaccine’s effectiveness. Organizations such as the American Diabetes Association advise people with diabetes to have a pneumonia vaccination and annual flu shots, and diabetic girls and women should ask their physician about how the new HPV vaccine may reduce the increased risk of cervical cancer that is associated with diabetes.
Patients are encouraged to consult their physician about the benefits and risks of aspirin. Regulators at the U.S. Food and Drug Administration are proposing tougher, mandatory warning labels for aspirin and other over-the-counter NSAIDs, such as the potential for stomach bleeding in people who are older than 60, have a history of gastric ulcers or bleeding, take anticoagulants, drink alcohol or take the drug for a period longer than directed.
Questions for your doctor
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about aspirin and diabetes:
- Should I take a daily aspirin to help prevent a heart attack, or do I need to avoid regular use of aspirin?
- If daily aspirin is not recommended for me, is it OK if I occasionally take aspirin?
- Is it safe for me to use aspirin if I have proteinuria, kidney disease, liver disease, stomach problems or other conditions?
- Is it safe for me to use aspirin if I take antidiabetic agents, anticoagulants or other medications?
- What dosage of aspirin should I take?
- When should I take my aspirin? Should I take it with food? Are there any other instructions I should know about taking it?
- If I have a sensitivity or allergy to aspirin, is there an alternative?
- What should I do if I miss a dose?
- What changes should I make to my diet when taking aspirin?
- How will aspirin interact with my current medications? Do I need to change my medication schedule or dosage?
- Do I need to avoid taking aspirin around the time I get a flu shot, HPV vaccine or other vaccination?
- How do I recognize the symptoms of an overdose of aspirin?
- What do I do in case of an overdose?
- What should I use for pain relief if I’m already taking aspirin daily?