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Should acetylsalicylic acid (ASA) be recommended for all patients who have type 2 diabetes but no history of cardiovascular disease (CVD)?
Two recent randomized controlled trials of ASA in type 2 diabetics addressed this question.
These findings are supported by the PPP (Primary Prevention Project) study of higher-risk patients without history of CVD.3
A recent meta-analysis combined JPAD1 and POPADAD2 with subgroups of patients with diabetes extracted from other studies and also found no overall advantage for ASA in primary prevention for those with type 2 diabetes.4
Canadian Diabetes Association guidelines5 correctly suggest that ASA is not necessary in all patients with diabetes but that it could be considered in “high-risk” groups.
High-quality evidence has not clearly identified which “high-risk” patients with diabetes will benefit from ASA (except perhaps those aged 65 or older).
According to current evidence, ASA should not be universally recommended for patients with type 2 diabetes who have no history of CVD.
Prescribe ASA to patients with diabetes judiciously and alter flow sheets, checklists, or current standards of care accordingly. In 1 study,1 the patients with diabetes who benefited from ASA had a mean 10-year CVD risk of more than 20%. You can estimate risk periodically by linking to online6 calculators (or adding paper-based7 calculators) in patients’ charts. Patients’ estimated CVD risk can inform discussion regarding starting (or stopping) low-dose ASA.
Tools for Practice articles in Canadian Family Physician are adapted from articles published twice monthly on the Alberta College of Family Physicians (ACFP) website, summarizing medical evidence with a focus on topical issues and practice-modifying information. The ACFP summaries and the series in Canadian Family Physician are coordinated by Dr G. Michael Allan, and the summaries are co-authored by at least 1 practising family physician. Feedback is welcome and can be sent to ac.cpfc@ecitcarprofsloot. Archived articles are available on the ACFP website: www.acfp.ca.
The opinions expressed in this Tools for Practice article are those of the authors and do not necessarily mirror the perspective and policy of the Alberta College of Family Physicians.