[Medscape] Is Aspirin being abused in older patients with diabetes?


The authors of a new study investigating trends in drug use say: Millions of American adults age 70 and older who were previously advised to take aspirin for primary prevention will no longer receive aspirin. recommend continued regular use – especially in diabetic patients at low risk of cardiovascular disease (CVD).

Cross-sectional study examining the use of aspirin for both primary and secondary prevention of cardiovascular disease (CVD) in older adults (>= 60 years), with primary prevention being the primary concern of patients in this age group, where harm, mainly bleeding, may be more harmful is beneficial.

In fact, twice as many older adults with diabetes could use aspirin for primary prevention than those without diabetes (odds ratio). [OR], 1.98).

The authors, led by Elizabeth Liu, Johns Hopkins University School of Medicine, Baltimore, Maryland, hypothesize that “older adults are more likely to abuse aspirin therapy if not actively stopped, especially in patients with diabetes,” in the JAMA Network Open article posted online June 21.

In an accompanying editorial, Wilson D.Pace, MD, medical director, DARTNet institute, Aurora, Colorado, points out that the study found that “a large proportion of individuals age 70 and older use aspirin use.” every day without knowledge about cardiovascular disease.”

Indeed, “more than 20% of people with a low risk of cardiovascular disease use aspirin daily,” he notes. “And this number has increased to more than 50% in people over 80 years old. This prevalence of aspirin use is not proven clearly based on current evidence and seems likely to do more harm than good.”

Guidelines and updated data for 2018

The revised guidelines from the American Diabetes Association (ADA) and the American College of Cardiology (ACC) 2021 recommend that aspirin use be considered for primary prevention in patients with diabetes. Sugar is associated with an increased risk of cardiovascular disease, with no associated bleeding risks, but this does not generally apply to patients 70 years of age and older.

The studies published in 2018 were a turning point. Evidence from three large trials (ASCEND, ASPREE, and ARRIVE) led to a change in ADA and ACC guidelines.

Both organizations discourage the use of aspirin as a primary prevention step for people over 70 with or without diabetes.

Findings from a new cross-sectional study suggest the potential to reduce aspirin intake in older adults. This new study is based on data on the preventive use of aspirin by 7103 adults over 60 years of age National Health and Nutrition Examination Survey (NHANES) in 2011-2018.

Overall, the rate of aspirin use — for primary or secondary prevention — among older US adults was 46.7%. For patients with diabetes, this rate is 61.7%; compared with people without diabetes is 42.2%.

Among people with diabetes, the probabilities of aspirin use in the older and younger age groups (reference: 60-69 years) were not significantly different in multivariate logistic models adjusted for race and sex. , education, CVD risk and body mass index.

“Preventive aspirin use was higher in older adults with diabetes than in those without diabetes,” the researchers said.

Extrapolating from their analysis, they argue that continued aspirin use would no longer be advisable for the 9.9 million older adults in the United States who were already using aspirin for primary prevention, particularly people with diabetes.

Going forward, it will be important to check whether changes to the guidelines made in 2018 have any effect on prescribing, they added.

Finally, future studies should examine the effect of updating the Guidelines on clinician behavior and the association between changing propensity to use preventive aspirin and progression of cardiovascular disease in the elderly,”

Talk to patients about aspirin use, reassess risks

Author Rita Kalyani, MD, also of Johns Hopkins, emphasizes the importance of starting the conversation about the benefits and risks of aspirin use in older patients.

“It is important for patients taking aspirin, as well as physicians treating people over the age of 70, with or without diabetes, to discuss whether they are taking aspirin for prevention. initially or not,” she told Medscape Medical News.

“If they are taking it, then on an individual basis they need to discuss together the potential benefits and harms involved in light of recently updated Guidelines and research,” she added.

Pace notes that most people over the age of 70 are not just starting aspirin, but starting maintenance therapy at a younger age.

“Stopping a therapy that seems to be working well for the individual can be a much more difficult decision for both the patient and the clinician than not starting therapy in the first place, “Pace said.

“Only through careful, ongoing evaluation; new doctors can ensure that they are following what many consider to be the most important ethical principle of the medical profession – the first principle, do not harm.”

Source: https://www.medscape.com/viewarticle/954915?fbclid=IwAR24BmuCJL3xLJWPxZh4XgLWO1M9DT_G49AwZ4bX8epNrzXG1zQApBed32Q#vp_2


JAMA Netw Open. 2021;4(6):e2112210. doi:10.1001/jamanetworkopen.2021.12210

The authors, including Liu and Kalyani, as well as Pace, have reported no relevant financial relationships.

The article is edited and translated by ykhoa.org – please do not reup without permission!

Translator: Gia Minh

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