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Patients With Diabetes Less Responsive to Aspirin Therapy?

When it comes to preventive aspirin therapy to reduce the risk of heart attack, clinicians should move away from the one-size-fits-all treatment approach. People with diabetes may be less responsive to low-dose aspirin therapy than people without the disorder, according to research presented at the American College of Cardiology's 56th Annual Scientific Sessions, held March 24–27 in New Orleans.

A group of researchers at the Center for Thrombosis Research at Sinai Hospital in Baltimore studied the effect of aspirin therapy on 120 volunteer participants with stable coronary artery disease, including 30 with diabetes. Participants were randomly assigned to take 81 mg, 162 mg, or 325 mg of aspirin daily for 4 weeks each, for a total of 12 weeks.¹

The response to aspirin was measured by methods that directly and indirectly measure inhibition of the cyclooxygenase-1 (COX-1) enzyme, including adenosine diphosphate (ADP)-induced aggregation and collagen-induced aggregation, an aspirin assay test that determines how well COX-1 is blocked in platelets, and the urinary thromboxane test that assesses how well COX-1 is blocked in vivo.

PEOPLE WITH DIABETES MAY BENEFIT FROM HIGHER DOSES OF ASPIRIN TO REDUCE HEART ATTACK RISK.

The group found that the prevalence of aspirin resistance was <5% among people with diabetes taking 81 mg daily based on the direct measurement of COX-1 inhibition. However, more variation in COX-1 inhibition was seen in indirect measures among people with diabetes, such as collagen-induced aggregation (27%, compared with 4% inhibition in people without diabetes).

Resistance to aspirin therapy in people with diabetes fell as the daily dosage of aspirin increased. Lead investigator Paul A. Gurbel, MD, and colleagues conclude from the study that people with diabetes may benefit from higher doses of aspirin. More clinical research is needed to determine an ideal aspirin dose for people with diabetes.

References

1. Gurbel PA: Effects of diabetes on the prevalence of aspirin resistance during low dose aspirin therapy. Presented at the 56th Annual Scientific Session of the American College of Cardiology, New Orleans, 2007. Published as abstract 1019–179, 2007.

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Services Email this article to a friend Similar articles in this journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Goldfarb, B. Search for Related Content PubMed Articles by Goldfarb, B. Social Bookmarking                What's this?