Questioning the potential impact of daily low-dose aspirin on the prevention of Type 2 diabetes.
Article Title: Aspirin and Risk of Type 2 Diabetes in Older Adults: A Cautious Approach
In a recent study presented at the Annual Meeting of the European Association for the Study of Diabetes, researchers investigated the impact of low-dose aspirin on the development of type 2 diabetes and fasting plasma glucose levels among older adults. The study, which included 16,209 participants aged 65 and over, found that daily low-dose aspirin (100 mg) was associated with a 15% lower risk of developing type 2 diabetes.
However, the potential benefits of aspirin in this age group are counterbalanced by the increased risk of bleeding complications. Low-dose aspirin selectively inhibits platelet COX-1, reducing clot formation and cardiovascular risk, but it also increases the risk of gastrointestinal bleeding, especially in older adults. This risk is cumulative with continued use, making aspirin use for primary prevention in older adults generally not recommended due to the heightened bleeding risk.
The Beers Criteria, a list of potentially inappropriate medications in geriatric adults for primary prevention, explicitly considers aspirin as one such medication. The increased risk of gastrointestinal bleeding and ulcers with age is significant, outweighing any potential mortality benefits in older adults.
It is important to note that the study's findings may not benefit the most at-risk population for type 2 diabetes, as it focuses on adults over 65. Dr. Jagdish Khubchandani expressed concern that the study's findings may not extend to younger adults who are at a higher risk of developing type 2 diabetes.
The study did not look at the effects of aspirin in patients taking other medications that would put them at a higher risk for bleeding, or in patients with known gastrointestinal disorders. Dr. Raj Dasgupta emphasized the need for individualized decisions about aspirin use in older adults, suggesting that lifestyle modifications such as diet, exercise, and sleep should be considered alongside aspirin as a means of preventing type 2 diabetes.
The study was a follow-up analysis of the ASPREE trial, a double-blind, placebo-controlled trial of aspirin. The original study, published in the New England Journal of Medicine in 2018, stated that aspirin conferred a 38% increased risk of major hemorrhage in older adults without any reduction in incidence of cardiovascular disease.
Dr. Khubchandani stated that the latest U.S. government guidelines do not support aspirin use even for cardiovascular events. He noted that too many people are taking aspirin when they are not at risk or when they should not be taking it. The decision to start aspirin should be tailored to patients' needs based on various factors, such as their risk of heart disease, lifestyles, tolerance for side effects, and other chronic diseases like diabetes.
In conclusion, while aspirin might reduce some cardiovascular or diabetes-related risks, in older adults the potential harms from bleeding complications generally outweigh these benefits. When used in older adults, gastroprotective strategies may reduce but do not eliminate bleeding risks. For primary prevention of type 2 diabetes or cardiovascular disease in older adults, aspirin is usually not recommended.
- The study on aspirin and type 2 diabetes in older adults also touched upon the role of science in understanding medical conditions like chronic diseases and their treatments.
- In addition to the risk of type 2 diabetes, the increased risk of bleeding complications due to aspirin use in older adults is a significant health and wellness concern, particularly with long-term use.
- The Beers Criteria, a list of potentially inappropriate medications in geriatric adults, highlights the heightened risk of gastrointestinal bleeding and ulcers associated with aspirin, even in the context of preventing chronic diseases like type 2 diabetes.
- When making decisions about pain medications like aspirin for older adults, medical professionals might consider various factors, such as the patient's risk of bleeding, chronic diseases, and personal lifestyle choices, in addition to the benefits for conditions like type 2 diabetes and cardiovascular diseases.
