Heart Disease: News You Can Use: Aspirin Therapy

As reported at the American College of Cardiology meeting in New Orleans in March, researchers have found that aspirin therapy does not have the same effectiveness in individuals with diabetes as it does in those without the disease.

The study, which followed 120 individuals with stable heart disease who were treated with varying doses of aspirin: 81 mg, 162 mg, or 325 mg per day. Thirty of the participants had diabetes, mostly type 2. A moderator at the conference, Dr. Robert S. Rosenson, M.D., of Northwestern University in Chicago, noted that the basis for this study was an observation that some individuals have heart attacks and strokes even though they are taking what would be thought to be an appropriate dose of aspirin based on their cardiovascular disease risk factors.

During the study, the researchers used several measures of the stickiness of the blood, called platelet aggrigation, to measure individual response to a dose. Adhearance to the medication protocol was strictly monitored, to assure that participants were taking their daily aspirin dose. The researchers found that some individuals have aspirin resistance, but that the rate is higher in those with diabetes. For the lowest aspirin dose, resistance to the effects of this medication to prevent platelets from sticking together ranged from 13% to 37% for diabetics and from 3% to 14% for those without diabetes. At a dose of 162 mg, rates ranged from 3% to 23% for diabetics and from 3% to 13% for non-diabetics, and in the highest dose of 325 mg, rates ranged from 3% to 23% for diabetics and from 0% to 16% for non-diabetics.

The researchers report that their results need further study, because we don't know yet what the difference is among individuals that makes them aspirin resistant, and because this study was very small, making its generalization limited. This preliminary study proved the researchers observations that there is a significant difference in response to aspirin therapy in those with diabetes and they plan to continue their research to determine who the individuals are that would benefit most from specific blood tests to determine their response to aspirin.

This is important because aspirin increases bleeding risk, and just increasing the dose in all individuals with diabetes would lead to a greater number of episodes of clinically significant bleeding, requring hospitalization. Platelet aggregation testing would also significantly increase the cost of what is now an inexpensive prevention measure.

For now I would recommend talking with your health care provider to determine your individual risk of developing cardiovascular disease (heart attack and stroke) and the most appropriate aspirin dose for you.

Take care,
Laurie

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