Aspirin Usage in Patients With Type 2 Diabetes
Aspirin Usage in Patients
Should aspirin be used in primary prevention of cardiovascular mortality and morbidity in patients with Type 2 diabetes?
Should aspirin be used in primary prevention of cardiovascular mortality and morbidity in patients with Type 2 diabetes?
Aspirin has been known to prevent and reduce the chances of cardiovascular diseases. However, there are many studies that have shown otherwise. This paper with the help of selected literature will show that aspirin cannot play roles in the prevention and reduction of cardiovascular disorders.
Drug Information
Aspirin is also known as acetylsalicylic acid. Aspirin is a salicylate-based medicine. Aspirin has often been used for the relief of minor pains and aches. Often the use of aspirin has been known as an antipyretic agent that can help in the relief of fever. Aspirin was isolated and purified by Felix Hoffmann, a German chemist. Salicylic acid is the main metabolic product of aspirin and has been known to be an important part of metabolic systems of animals and humans. In the case of humans, it has been reported that salicylic acid is an important part of human diet where the synthesis of aspirin takes place in an endogenous manner 1.
It has been reported that the production of thromboxane is prevented and slowed down by Aspirin. This is more termed as its antiplatelet effect. When blood vessels are damaged, the platelets become attached to the thromboxane, which causes the formation of a clump of platelets on the inner side of blood vessels. Bearing in mind the fact that the patch of the platelets can grow into larger sizes and these patches can play roles in blockage of the vessels. Based on the functions of aspirin, it has been seen that in order to prevent the formation of platelet patches, aspirin is administered to the heart patients in low doses.
Previous literature
Most of the studies carried out to date have mentioned the fact that aspirin can be used for the prevention of heart attacks in heart patients. In most of the cases, it has been reported that after the first heart attack, the administration of aspirin makes sure that the second heart attack is prevented. Based on the clinical studies it has been seen that aspirin is also used to prevent the risks of heart attack.
The studies have reported that there are two main modes of usage of aspirin for the prevention of cardiovascular conditions. These two modes include primary prevention as well as the secondary prevention. In the case of primary prevention, aspirin is used in healthier population for the reduction of risks of heart attacks. Secondary prevention is for those who have been diagnosed for cardiovascular conditions. The studies in the past have shown that low doses of aspirin can be used for the prevention of heart attacks. The chances and risks of heart attacks and ischemic strokes are reduced to about 20% in people administered with aspirin. With this, it has been additionally reported that aspirin does not come without risks. With double an increase in the risks of hemorrhaging strokes and bleeding from the vessels, aspirin has been counted as a risk itself. In addition, it has been reported that people without cardiovascular conditions do not advantage as much as people suffering from heart conditions. The studies have reported more than 10% reduction of chances of heart attacks in heart patients 2.
In these cases, there are many lobbies that talk in favor of and against the use of aspirin for the prevention of heart conditions. In most of the cases, it has been seen that the primary prevention has been achieved by adding aspirin in polyp ills. The usage of polypill has been rejected. It has been recommended by the U.S. Government Preventive Services Task Force that the use of such medicines should be based on personal preferences of the patients, their consent, and their health conditions.
One of the most important clinical trials has shown that aspirin does not seem to have an effect on low risk heart conditions. Risk reduction was seen in the case of patients who had serious heart conditions. 12% risk reduction was seen in the case of serious myocardial infarction heart patients. In the case of patients with low risk myocardial infarction, the risk reduction was only 0.18%. No significant effect of aspirin was seen in reduction of the strokes. Many side effects were seen in the patients who were administered with aspirin and these included extra-cranial bleeding and gastrointestinal hemorrhages. One of the most important facts that have been mentioned in the study is that the risk factors that are counted among the risks for serious heart conditions were also counted for gastrointestinal and extra-cranial bleeding. Thereby the study has concluded that the overall effect of aspirin in the reduction of heart conditions and in the reduction of risks of heart attacks is of uncertain value. The risks that aspirin poses for internal bleeding are higher as compared to the risks of heart malfunctions. It is important that further trials are conducted that can help in calculating the risks that are posed by aspirin in primary prevention as well as secondary prevention 1 (239).
Another important finding has shown that effects of aspirin are lesser as anticipated in primary prevention. The ten-year study has found that the effects on women over 65 years of age are much lesser in primary prevention scenario as compared to the effects seen in men. 100 mg of aspirin was administered to the women and no reduction in the risks of heart attacks could be observed. Thereby from here, the most interesting aspect of the study is based on the gender difference. Previously all conclusive studies on aspirin and its effects on heart attacks and cardiovascular disorders have focused on men. In one of the studies conducted in 1985, it was concluded that aspirin can protect everyone from a heart attack aged between 40 and 84. Additionally it was concluded that men who took 325 mg of aspirin on a regular basis were at a 44% lesser risk of having a heart attack. In the case of study mentioned, women tested after taking aspirin had a 9% lesser chance of heart attack as compared to women who were on placebo. The difference of 9% is lower 3.
In one other study, it has been clearly mentioned that aspirin is not helpful in preventing cardiovascular risks and it cannot prevent the risk of developing cardiac malfunctions. The study published in Drugs and Therapeutics Bulletin has mentioned that it has remained a practice since many years that men and women taking aspirin on a daily basis will be at a much lower risk of developing risks for heart attack and cardiac malfunctions. Since the year 2005 and 2006, many medical professionals have recommended the dosage of aspirin for patients having heart troubles. Some of the main criteria of patients who are included in the list are the ones with type 2 diabetes and high blood pressure. The study has mentioned that the benefits and risks that are offered by the use of aspirin need to be counted and there is a need to analyze the levels of risks that are offered by usage of aspirin on a daily basis. This study concluded with the help of six studies previously done that the usage of aspirin does lower the risk of heart attack but it doubles the risks of gastrointestinal hemorrhages which can prove to be fatal. On the other hand, it has been mentioned that people who do not have heart or cardiac malfunctions should not take aspirin on a daily basis as taking it will not help in the reduction of heart complications. However, aspirin dosage on the daily basis will increase the risks of internal bleeding 3. The bulletin and the findings of the bulletin have been supported by the Royal College of GPs and it has been mentioned that there is a need that doctors and practitioners paly roles in increasing the awareness in relation to the risks being posed by aspirin usage on the daily basis4.
These sets of studies can be concluded by adding that daily usage of aspirin can help in the prevention of heart attacks in people who do not suffer from serious heart complications. Secondly, people who have been diagnosed to have serious heart complications can have some minor effects with the usage of aspirin but in these cases, increased risks are being posed, as aspirin can be one of the main reasons of gastrointestinal bleeding and internal hemorrhages.
Another important speculation that has been made for aspirin is that it can also prevent the risk of heart attacks in diabetics. Recent studies have shown that in the case of diabetics, aspirin cannot help in the prevention of first heart attack. Previous studies have mentioned that prevention of heart attacks is possible with consistent usage of aspirin. However, the recent study conducted by the British Medical Journal has shown that the diabetics who do not suffer from heart complications do not gain any benefit from the usage of aspirin. In these cases, it has been mentioned that only those diabetics can benefit from the use of aspirin that have had a heart attack in the past. Thus, the usage of aspirin can help in prevention of any future heart attacks3 (p. 2365).
Analysis of Chosen studies
Study 1
The first study “Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain,” has been conducted on diabetic patients. It has mentioned that diabetics are at an increased risk of cardiovascular malfunction as compared to normal population. As the title of the study indicates, the focus is on the diabetics in Spain. They study has focused on the effects of using certain drugs and medications in order to reduce or to prevent the risk of heart attacks in diabetics. The study has mentioned that the usage of salicylic acid for primary and secondary prevention has been allowed by the American Diabetes association to be used on the patients who fall in the category of primary or secondary prevention. The main aim of the study was to see the effects of recommended medications on preventive care in diabetics in Spain. The data of the study is based on the patient data spanning two years. Variables that have been included in the study are age, sex, social status, and primary care center identification. Some of the main measures that have been included in the study are use of aspirin or any other drugs, clinical parameters, rates and incidents of co-morbidities and the proportion of patients as therapeutic targets. In order to calculate levels of significance in the data collected, chi-square test, descriptive statistics, and regression was used 5.
Critique
The data has shown that the usage of aspirin is lower in Spain in the case of diabetics. It is important to see that the data added in the study points towards the lesser or no effects of aspirin on diabetics who have not yet had a heart attack. Secondly, the data also suggests that there are increased risks of usage of aspirin on diabetics based on risks of internal bleeding. An important fact that needs to be mentioned here is that the study should have suggested lesser use of aspirin in diabetics as compared to what has been suggested. On the other hand, the patient data collected by the study is of lesser variance as compared to the need and requirements of the study. The usage of aspirin is in a need to be reduced. It is important that the focus of data collection and analysis was varied and wider. The data published in the study is based on the estimates of usage of aspirin in Spain. In fact, the data should have been analyzed for the side effects of aspirin seen in diabetics in the category or primary and secondary prevention. But one of the main facts that have been mentioned in the study is that the usage of aspirin in patients of older age is higher as compared to younger patients. The data in the study has been collected covering a total of two years, but still the number of patients that have been analyzed is more than 4000, which is a strong point. One of the main facts that need to be highlighted here is that there is a need to reduce the usage of aspirin in the patients of older ages based on additional risks that are posed by aspirin. Although the fact seems to be missing in the study as it was important to be mentioned the reason and associated risks based on which aspirin is used lesser in younger people as compared to older ones.
Study 2
The second study “Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients with Type 2 Diabetes.” The main aim of the study was to investigate the effects of low dose aspirin in the patients with type 2 diabetes. The study has been conducted over a period of six years in japan. More than 163 medical institutions have been included in the study with more than 2600 patients. The patients have been chosen based on 5 years of follow up being diagnosed for type 2 diabetes. there are various dimensions of the study as the kind of trials that have been conducted in the study are open ended, random, end pointed, and randomized. Generally, high dosage of aspirin of 325 mg per day is recommended for high risk patients. However, as thus study focused on patients with lower risks of heart attack based on which the included trial patients were administered 80 to 100 mg of aspirin on a daily basis. Two cohorts of the patients were formed, one was administered with aspirin, and second group was the non-aspirin group. The study has concluded that there was no difference between the two groups as no risk reduction of heart attacks could be deduced in the two groups even after the administration of aspirin. The second important finding of the study was in relation to the extreme side effects of aspirin in the two groups after administration. The dosage was lower, based on which there were lesser side effects 6.
Critique
The study is an important study as the diversity of the study is much greater as compared to the first study. Statistical techniques have not been used in the study other than the use of confidence intervals. On the other hand, it can be seen that based on greater diversity of the data collected and the results obtained, the findings are more conclusive and stronger. The study has concluded that there are lesser effects of low dose aspirin on the patients with type 2 diabetes. The study has only focused on the patients included in the primary prevention. The study would have been stronger in the presence of the patients included in the secondary prevention category. Primary prevention is an important step. But more important is the secondary prevention as patients who have been diagnosed with cardiac malfunctions are the ones who need to be tested for the effects of aspirin in its low and high dosage. The study has concluded that the effects of low dosage aspirin are lesser in type 2 diabetes patients. Thereby from here, it can be added that there is a need of further studies that can show the effects of higher dosage in patients with diabetes in primary as well as secondary prevention.
Conclusion
The studies included in the paper for analysis have shown that aspirin has lesser effects on diabetic patients in the primary care. Recent secondary and tertiary literature has suggested that there is a need to change the regime of administering aspirin in low and high dosages to the patients. Firstly, there may be some reduction in the risks of cardiovascular arrest in the patients after using aspirin but the risks that are posed by aspirin are much higher and fatal as compared to the heart attack itself. Aspirin has been shown to have no effect on people younger than 65 years in reducing risks of heart attack. Secondly, even if positive effects of aspirin are seen in reducing risks of heart attacks, it has been noticed in the case of people suffering from low risk myocardial infarctions. In the case of people with serious heart complications, aspirin fails to induce any positive effects.
References
1. Chan KLF, Jessica YL, Ching MPH, Lawrence CT, Hung MD, Wong VSW, Leung KSV, Kung NN, Hui, AJ, Wu JCY, Leung KW, Lee WYV, Lee K, Lee TY, Lau WY, to FK, Chan HLY, Chung S, and Sung JJY. Clopidogrel vs. Aspirin and Esomeprazole to Prevent Recurrent Ulcer Bleeding. N Engl J. Med. 2005; 352:238-244.
2. Falk E, and Fernandez-Ortiz a. Role of thrombosis in atherosclerosis and its complications. American Journal of Cardiology. 1995: 75: 5B-11B.
3. Smith CS, Allen J, Blair JN, Bonow or, Brass LM, Fonarow, CG, Grundy, MS, Hiratzka L, Jones D, Krumholz, HM, Mosca L, Pasternak CR, Pearson T, Pfeffer MA, and Taubert KA. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update, Endorsed by the National Heart, Lung, and Blood Institute. Circulation. 2006; 113: 2363-2372.
4. Keith a. Regulating Information About Aspirin and the Prevention of Heart Attack. The American Economic Review. 1995: 85: 96-99.
5. Sicras-Mainar a, Navarro-Artieda R, Rejas-Gutierrez J, Fernandez-de-Bobadilla J, Frias-Garrido X, and Ruiz-Riera R. Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain. BMC Family Practice. 2007: 8:60.
6. Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, Jinnouchi H, Sugiyama S, and Saito Y. Low-Dose Aspirin for Primary Prevention of Atherosclerotic Events in Patients With Type 2 Diabetes: A Randomized Controlled Trial. JAMA. 2008; 300(18):2134-2141.
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