Observational study of patients seen in primary care in the United Kingdom
Older patients with type 2 diabetes and heart failure (HF) who take aspirin for primary prevention have a lower mortality, specifically all-cause mortality with or without HF hospitalization over 5-year follow-up, a large study found. But they were more likely to have a nonfatal myocardial infarction (MI) or stroke, Medscape Medical News reports.
Surprisingly, bleeding risks were similar in both groups.
The findings are from an observational study of patients seen in primary care in the United Kingdom, with lead author Charbel Abi Khalil, MD, Weill Cornell Medicine-Qatar, Doha.
The findings were presented at the American College of Cardiology at the American College of Cardiology (ACC) 2018 Scientific Sessions.
"There are no clear guidelines on aspirin use in this category of patients" with type 2 diabetes and HF and no prior stroke or MI, and this explains why in this study, half were receiving aspirin and half were not, Abi Khalil told Medscape Cardiology.
"We were surprised to see a paradoxical increase in nonfatal heart attacks and nonfatal stroke, parallel to the decrease in mortality," he said in a statement, speculating that patients in this age group were more likely to have a cardiac event.
Physicians should estimate an individual patient's risk of future cardiovascular events by using an established risk calculator, and then balance this with the potential risk for bleeding, to determine whether aspirin therapy is warranted, comments Paul A Gurbel, MD, Inova Heart and Vascular Institute, Falls Church, Virginia, who was not involved in the study.