Diabetics Urged To Take Aspirin

From: http://www.healthscout.com/cgi-bin/WebObjects/Af.woa?ap=1&idx=107422

Expert says one-a-day dose cuts heart risk

By Neil Sherman
HealthScout Reporter

THURSDAY, Jan. 18 (HealthScout) -- Everyone with diabetes should take a baby aspirin every day, a leading expert in heart disease and diabetes suggests today.

People with diabetes have a higher risk for heart attacks and strokes because they're more likely to have blood clotting problems. Taking an aspirin is a cheap, safe, and effective way of preventing dangerous blood clots, says Dr. Henry Ginsberg, director of Columbia University's Irving Center for Clinical Research in New York City.

He says, "There are at least several blood abnormalities associated with insulin resistance and diabetes, and aspirin, in particular, has been shown in several studies to prevent cardiovascular events."

Ginsberg says diabetes changes the fat content in blood "where the triglycerides are higher and the HDL, the good cholesterol, is lower." The disease wreaks havoc with the chemicals that control blood clotting as well, Ginsberg says. "Two of the several clotting factors are increased in people with diabetes, and the one factor that helps break down clots is also increased. Therefore you're much more likely to form clots, and you're much less likely to break them down," he says.

Couple that with increased blood pressure, a common risk factor in people with diabetes who tend to be overweight and exercise less, "and you have the common recipe for risk of coronary heart disease," Ginsberg says.

More than 15 million Americans have diabetes. Most have the adult-onset, or Type II, a condition in which cells lose sensitivity to the hormone insulin, which helps the body extract sugar from blood. People with Type II diabetes can handle the disorder through diet or drugs, whereas Type I diabetics must have insulin injections daily.

Baby aspirin just the right dose

Ginsberg says that high insulin levels in Type II diabetes cause "the blood vessels not to respond normally, so they don't open and carry more blood," resulting in a buildup of plaque in the coronary artery. "In diabetics that process progresses faster, the plaque is more likely to rupture and to form a clot," and cause a heart attack or stroke.

"Aspirin plays a major rule in preventing those blood clots from forming or getting bigger. And in people with [Type I or insulin-dependent] diabetes, platelets tend to clump more, and aspirin prevents that as well. And finally, we are beginning to look at the issue of inflammation in coronary disease, and aspirin is an anti-inflammatory," Ginsberg says.

The bottom line is that "every diabetic should be taking a baby aspirin every day," Ginsberg says. "That looks like a large enough dose and minimizes the chances of bleeding." Ginsberg presents his recommendations at an American Medical Association media briefing today in New York City.

Everyone who has diabetes is at risk for cardiovascular disease, says Dr. John Colwell, professor of medicine and director of the Medical University of South Carolina's Diabetes Center, in Charleston. Colwell studied aspirin for the American Diabetes Association.

"Diabetics are two- to four-fold more at risk for heart attacks and for cardiac death than those who don't have diabetes. And it's higher in certain ethnic groups, like African Americans, Hispanics and Native Americans," Colwell says.

"And there are four studies that have shown that low-dose aspirin in diabetics reduces the risk of having a heart attack by 25 to 30 percent," Colwell says.

The American Diabetes Association in 1997 recommended the "use of aspirin for anyone with diabetes with one or more risk factors: cardiovascular disease, being overweight, a family history of heart disease, smoking, elevated cholesterol levels and the presence of protein in the urine," says Dr. Marian Parrott, vice president of clinical affairs for the association. "What we say is that for primary protection, start aspirin at the age of 40, and if you've had a heart attack you can start aspirin earlier."

Parrott cites one caveat: "People under the age of 21 should not take daily aspirin, because there is a small risk of Reye's syndrome." The disease is associated with the use of aspirin during a viral infection. It affects all organs of the body, but most lethally the liver and the brain.

What To Do

If you are a diabetic, talk to your doctor taking aspirin.

For more on aspirin and diabetes, read the article from the American Diabetes Association. For more on the disease, go to the National Institute of Diabetes and Digestive and Kidney Diseases.



SOURCES: Interviews with Henry Ginsberg, M.D., director, Irving Center for Clinical Research, College of Physicians and Surgeons, Columbia University, New York City; John Colwell, M.D., Ph.D., professor of medicine, director, Diabetes Center, Medical University of South Carolina, Charleston; Marian Parrott, M.D., vice president of clinical affairs, American Diabetes Association, Alexandria, Va.

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