Should People with Diabetes Take Aspirin?

First, let’s explore the links between aspirin, diabetes, and cardiovascular disease.

How does cardiovascular disease lead to cardiovascular events?

A cardiovascular event like a heart attack or stroke can happen when blood flow is blocked to an important organ. Heart attacks are caused by blocked blood flow to the heart, and strokes take place because of blocked blood flow to the brain.

These cardiovascular events typically occur due to the effects of something called atherosclerosis.

In atherosclerosis, a fatty substance called plaque builds up on the walls of the arteries. This can narrow the arteries and reduce the amount of blood that can flow through them. In severe cases, plaque may block an artery entirely.

Plaque can also tear, or rupture. When this happens, it can lead to the formation of blood clots. A blood clot can either block the affected artery or break away and block another artery in the body, such as one in the heart or brain.

How does diabetes increase your risk of cardiovascular events?

People with diabetes have high blood sugar. When blood sugar levels are not managed, it can lead to damage in the blood vessels as well as the nerves associated with them.

Additionally, people with diabetes are also more likely to have other risk factors for cardiovascular disease. These include things like high blood pressure (hypertension) and high cholesterol.

How can aspirin reduce the risk of a cardiovascular event?

Low-dose aspirin inhibits the enzyme cyclooxygenase-1 (COX-1). When COX-1 activity is reduced, it leads to lower levels of a molecule called thromboxane A2, which normally increases platelet aggregation and blood clotting.

Simply put, aspirin works to reduce the activity of platelets, the part of blood that’s involved in clotting. Aspirin thins the blood and helps prevent blood clots from forming.

Because of its blood-thinning properties, taking daily aspirin can increase the risk of bleeding events. This can include more mild events like bruising easily or nosebleeds.

However, serious bleeding events can also happen, such as bleeding events in the gastrointestinal (GI) tract or brain. Because of this, a healthcare professional must weigh the benefits of daily aspirin against its potential risks.

According to a 2019 report, the ADA only recommends daily aspirin at a dose of 75 to 162 milligrams per day for people with diabetes and a history of cardiovascular disease.

The ADA notes that daily aspirin may also be considered for people with diabetes who are at an increased cardiovascular risk. You may be at an increased cardiovascular risk if you are 50 or older and:

• have a personal history of:
  • high blood pressure
  • dyslipidemia, which refers to unhealthy levels of one or more types of lipid
  • chronic kidney disease or albuminuria
• have a family history of early cardiovascular disease, defined as males younger than 55 and females younger than 65
• are a current smoker

However, it’s important to discuss the risk of bleeding events with your doctor. It’s also possible that your doctor will want to assess your risk of bleeding before recommending daily aspirin.

Why isn’t daily aspirin recommended if you don’t have cardiovascular disease?

A 2018 study focused on daily aspirin use in adults with diabetes who had no history of cardiovascular disease.

The study included 15,480 participants, half of which received daily aspirin. The other half of the participants received a placebo. Researchers followed up with participants over an average period of 7.4 years. They found that:

• Serious cardiovascular events occurred in a significantly lower percentage of the participants taking daily aspirin (8.5 percent) compared to those taking the placebo (9.6 percent).
• However, serious bleeding events also happened significantly more in people taking aspirin (4.1 percent) compared to the placebo (3.2 percent).

The researchers concluded that, for people with diabetes and no history of cardiovascular disease, the risks of daily aspirin appear to outweigh the potential benefits.

However, a 2019 review of studies did not see the same risk for bleeding events. The review included data from 34,227 people with diabetes who had no history of cardiovascular disease. The researchers found that:

• Daily aspirin lowered the risk of cardiovascular events by 11 percent.
• Taking daily aspirin did not cause a significant increase in bleeding risk.
• Researchers noted that real-world data has shown higher rates of bleeding in people with diabetes who take daily aspirin, even if this review did not show the same results.

Researchers concluded that aspirin has potential benefits of preventing cardiovascular events in people with diabetes, but the benefit could be counterbalanced by the bleeding risk.

For now, the researchers say recommendations of low-dose daily aspirin should be individualized based on a person’s current cardiovascular health and bleeding risk.

There are other options to lower your risk of cardiovascular events if you’re allergic to aspirin or cannot take it.

You may be able to take the blood-thinning medication clopidogrel (Plavix) instead. However, like aspirin, clopidogrel is also associated with a risk of bleeding events.

If you have diabetes, there are several other ways you can help prevent cardiovascular issues. Let’s take a look at these ways now.

Manage your blood sugar

Remember that high blood sugar levels can cause damage to your blood vessels and raise your risk of a cardiovascular event. Because of this, always take your diabetes medications as directed by your doctor.

Additionally, be sure to check your blood sugar levels at least once a day. If you find that your readings are consistently outside your target range, make an appointment with your doctor to discuss this.

It’s also important to have a doctor check your A1C levels every 3 to 6 months. This measures your average blood sugar levels over the past 3 months.

Treat high blood pressure and high cholesterol

Underlying conditions like high blood pressure or high cholesterol can increase your risk of cardiovascular disease. If you have one or both of these conditions, take steps to manage them.

High blood pressure can be managed with a variety of different medications, such as beta-blockers or ACE inhibitors. Additionally, lifestyle changes like reducing stress, eating a healthy diet, and not smoking can also help.

High cholesterol can also be treated with medications, lifestyle changes, or both. The medications used to lower cholesterol levels are called statins.

Eat a heart-healthy diet

Try to have heart-healthy foods in your diet. Some examples include:

• fresh fruits and vegetables
• whole grains
• fish
• chicken or turkey
• lean cuts of meat
• low fat dairy items

It’s also important to avoid some types of foods, such as:

• foods high in salt, sugar, or saturated fat
• items that contain trans fats
• processed foods
• refined carbohydrates

If you smoke, try to quit

Smoking is a risk factor for many different health conditions, including cardiovascular disease. One effect of smoking is narrowing your blood vessels, which can reduce blood flow.

If you smoke, take steps to quit. It may be helpful to work with your doctor to develop a plan to quit that you can follow.

Get regular exercise

Getting regular exercise can help with keeping your heart healthy and managing weight. A good rule of thumb is to get at least 30 minutes of exercise most days of the week.

Another step you can take is to try to sit less. This is particularly important if you work in a sedentary, or desk, job. Try to get up and move around every 30 minutes or so.

Take steps to manage weight

Losing weight, if necessary, can help improve your heart health. Be sure to talk with your doctor about healthy ways to lose weight.

If you have diabetes and are concerned about your cardiovascular risk, ask your doctor about daily aspirin. They can help you decide if it may be beneficial in your individual situation.

Don’t take daily aspirin before talking with your doctor first. It’s possible it may not be recommended for you, particularly if you don’t have a previous history of cardiovascular disease, heart attack, or stroke.

You may also want to talk with your doctor before using daily aspirin if you:

• are over the age of 70
• drink alcohol frequently
• have a risk of bleeding events like GI bleeding or hemorrhagic stroke
• are planning to have any medical or dental procedures
• have had a previous allergic reaction to aspirin

When to seek emergency care

It’s important to be able to recognize the signs of a cardiovascular event like a heart attack or a stroke so you can seek medical attention.

Signs of a heart attack are:

• pain, pressure, or tightness in your chest that lasts longer than a few minutes
• pain in your:
  • jaw
  • neck
  • back
  • shoulder
  • arms
• shortness of breath
• fatigue
• feeling lightheaded
• increased sweating
• digestive symptoms like upset stomach, nausea, or vomiting

The symptoms of a stroke are:

• one-sided weakness or numbness affecting your face, arm, or leg
• headache that comes on suddenly and is severe
• feeling dizzy or lightheaded
• vision problems
• trouble speaking, walking, or keeping your balance
• confusion

Call 911 or go to the emergency room if you experience any symptoms of a cardiovascular event. It’s okay if you’re not sure if you may be having a heart attack or stroke. What’s important is that you receive prompt medical attention.

Although it can help lower the risk of cardiovascular events like heart attack and stroke, daily low-dose aspirin may not be recommended for everyone with diabetes. This is because daily aspirin carries the risk of serious bleeding events.

If you have diabetes and are concerned about cardiovascular disease, talk with your doctor about daily aspirin. Your doctor can help assess your cardiovascular risk level to determine if daily aspirin is recommended for you.

There are also other ways you can improve your cardiovascular health if you have diabetes. These include managing your blood sugar, treating other health conditions, and eating a heart-healthy diet.