Can a daily low-dose aspirin help reduce the risk?

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Experts say the benefits of daily low-dose aspirin may not outweigh the concerns over its use in older adults. aquaArts studio/Getty Images
  • In a new study, researchers says low-dose aspirin could lower risk of type 2 diabetes in people over 65.
  • Earlier studies have indicated that regular use of low-dose aspirin can cause bleeding.
  • Doctors not involved with study say that although the new study makes good points, there are too many factors to say regular aspirin use is safe.

A new analysis out this week states that the use of low-dose aspirin could potentially lower the risk of type 2 diabetes in people over 65.

The report will be presented in early October at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany.

The authors did a follow-up study of the ASPREE trial – a double-blind, placebo-controlled trial of aspirin, the principal results of which were published in the New England Journal of Medicine in 2018.

This original study stated that aspirin conferred a 38% increased risk of major hemorrhage in older adults without any reduction in incidence of cardiovascular disease.

In the new study, researchers, led by Sophia Zoungas, a professor in the school of public health and preventive medicine at the Monash University in Melbourne, Australia, said in a statement that the researchers’ work shows that using a low dose (100 mg daily) of aspirin daily among adults 65 and older is associated with a 15% lower risk of developing type 2 diabetes.

The team said the results show anti-inflammatory agents such as aspirin warrant further study in the prevention of diabetes.

The authors said the effect of aspirin on incident type 2 diabetes among older adults remains uncertain.

This study investigated the randomized treatment effect of low-dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels among older adults.

The latest study looked at community-dwelling people 65 or over who were free of cardiovascular disease, independence-limiting physical disability, and dementia.

Participants were randomized 1:1 to 100 mg daily aspirin or a placebo.

The researchers defined incident diabetes as self-report of diabetes, commencement of glucose lowering medication, and/or a fasting plasma glucose (FBP) level of 7.0 mmol/L or higher at annual follow-up visits.

The team excluded subjects with diabetes at the beginning of the study.

Through computer and statistical modeling, researchers assessed the effect of aspirin on incident diabetes and FPG levels.

The analysis included 16,209 participants (8,086 randomized to aspirin and 8,123 to placebo).

During a median follow-up of 4.7 years, 995 incident diabetes cases were recorded (aspirin: 459, placebo: 536). Compared with placebo, the aspirin group had a 15% reduction in incident diabetes and a slower rate of increase in FPG (difference in annual FPG change: -0.006 mmol/L).

The authors said in a statement “Aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults.”

“Given the increasing prevalence of type 2 diabetes among older adults, the potential for anti-inflammatory agents like aspirin to prevent type 2 diabetes or improve glucose levels needs further study,” they added.

“The earlier published trial findings from ASPREE in 2018 showed aspirin did not prolong healthy independent living but was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract,” said Zoungas. “Major prescribing guidelines now recommend older adults take daily aspirin only when there is a medical reason to do so, such as after a heart attack.”

“Although these new findings are of interest, they do not change the clinical advice about aspirin use in older people at this time,” Zoungas said.

Jagdish Khubchandani, PhD, a professor of public health at New Mexico State University, told Medical News Today he sees problems with the study.

“More than a third of the people in the U.S are overweight and a third are obese,” Khubchandani said. “The age of onset of [type 2] diabetes is most common in the range of 40 to 65 years. So, it is unclear how a study of adults more than 65 years of age will benefit the most at-risk population, even if we assume that the study findings are valid and reliable.”

Khubchandani added that the study could also give people the wrong idea.

“A potential problem I see is people now taking aspirin without knowing the details of the study and understanding the risk of bleeding that accompanies aspirin consumption,” he said. “As is, studies have shown that too many people are taking aspirin when they are not at risk or when they should not be taking it.

“While some studies have shown reduction in cardiovascular events – e.g., heart attacks – with aspirin consumption, many studies show no benefit or on the contrary, higher risk of death. As of today, the latest U.S. government guidelines do not support aspirin use even for CV events,” Khubchandani said.

Dr. Pouya Shafipour, a family and obesity medicine physician at Providence Saint John’s Health Center in California, told Medical News Today it’s long known low-dose aspirin has strong, anti-inflammatory, and anti-platelet benefits.

“However, it really needs to be individualized as it increases the risk of bleeding, gastric ulcers, cerebral hemorrhage, and has other potential dangerous side effects,” Shafipour said. “The risks in this case as a blanket statement significantly outweigh the benefits. Recommendations for a low-dose aspirin in the setting of someone with diabetes or other medical conditions that could potentially benefit, needs to be individualized and evaluated by, the physician who is familiar with the patient’s history and active conditions to ensure it does not increase risk of gastric ulcer, G.I. hemorrhage, or brain hemorrhage in addition to other side effects or drug interactions.”

“Elderly individuals are at higher risk of fall, which increases risk of potentially fatal brain hemorrhage,” Shafipour added. “It is no surprise that anti-inflammatory benefits of aspirin are important in preventing diabetes, but a healthy, low carbohydrate, Mediterranean diet, exercise, and improving eating behaviors could have similar or better benefits than added, low-dose aspirin.”

Dr. Raj Dasgupta, a specialist in internal medicine, pulmonary, critical care and sleep medicine and the chief medical advisor for Sleep Advisor, told Medical News Today the study had its merits.

“The study has several strengths, including a large sample size and an extended follow-up period,” Dasgupta said. “However, it also did not look at the effects of aspirin particularly looking at patients taking other medications that would put them at a higher risk for bleeding, or in patients with known gastrointestinal disorders, such as ulcers or gastritis.”

“It would be interesting to compare lifestyle modifications such as diet, exercise and sleep compared to just taking aspirin alone, in regards to developing type 2 diabetes,” Dasgupta said. “It would also be interesting to use hemoglobin A1c (HbA1c) as an end point in the study and not just fasting plasma glucose.”

Khubchandani noted that whether to take aspirin regularly includes various factors.

“The decision to start aspirin should be tailored to patients needs based on many factors, such as their risk of heart disease, lifestyles, tolerance for side effects, other chronic diseases like diabetes, just to name a few,” he said.

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