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Feature Article

Cardioprotective aspirin in type 2 diabetes

Leslie Jackowski, Dan Worthley, Pat Phillips
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Abstract

There is strong evidence supporting the use of low-dose aspirin in the secondary prevention of cardiovascular events in patients with type 2 diabetes but the evidence is less robust in primary prevention. Also, aspirin use can be associated with serious gastrointestinal haemorrhage.

Key Points

  • Cardioprotective doses of aspirin may prevent and/or delay cardiovascular events in patients with or without diabetes but can be associated with serious gastrointestinal (GI) haemorrhage.
  • The current recommendation is that low-dose aspirin be considered for both primary and secondary prevention of cardiovascular events in people with type 2 diabetes. This may change when the results are known of a trial of low-dose aspirin in patients with type 2 diabetes but no known coronary heart disease.
  • Patients at higher risk of GI bleeding include the biologically old, those who have a past history of an upper GI bleed, Helicobacter pylori infection or type 2 diabetes and those taking certain medications.
  • In patients at high risk for an upper GI bleed, H. pylori testing and treatment should be considered prior to starting aspirin.

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