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Experts say the benefits of daily low-dose aspirin may not outweigh the concerns over its use in older adults. aquaArts studio/Getty Images
  • In a new study, researchers say low dose aspirin could lower the risk of type 2 diabetes in people over 65.
  • Earlier studies have indicated that regular use of low dose aspirin can cause bleeding.
  • Medical experts say the new study makes good points, but there are too many factors to say regular aspirin use is safe.

A new analysis out this week states that using low dose aspirin could potentially lower the risk of type 2 diabetes in people over 65.

The report will be presented in early October at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany.

The authors did a follow-up study of the ASPREE trial, a double-blind, placebo-controlled trial of aspirin, the principal results of which were published in the New England Journal of Medicine in 2018.

This original study stated that aspirin conferred a 38% increased risk of major hemorrhage in older adults without any reduction in incidence of cardiovascular disease.

The study investigated the randomized treatment effect of low dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels among older adults.

The researchers looked at community-dwelling people 65 or over who were free of cardiovascular disease, independence-limiting physical disability, and dementia. They excluded subjects with diabetes at the beginning of the study.

Participants were randomized 1:1 to 100 mg daily aspirin or a placebo. The analysis included 16,209 participants (8,086 randomized to aspirin and 8,123 to placebo).

Through computer and statistical modeling, researchers assessed the effect of aspirin on incident diabetes and FPG levels.

The researchers defined incident diabetes as self-report of diabetes, commencement of glucose-lowering medication, and/or a fasting plasma glucose (FBP) level of 7.0 mmol/L or higher at annual follow-up visits.

During a median follow-up of 4.7 years, 995 incident diabetes cases were recorded (aspirin: 459, placebo: 536).

Compared with placebo, the aspirin group had a 15% reduction in incident diabetes and a slower rate of increase in FPG (difference in annual FPG change: -0.006 mmol/L).

“Aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults,” the authors said in a statement.

Lead researcher Dr. Sophia Zoungas, PhD, an endocrinologist and professor in the School of Public Health and Preventive Medicine at the Monash University in Melbourne, Australia, said in a statement that daily low dose aspirin (100 mg daily) is associated with a 15% lower risk of developing type 2 diabetes among adults ages 65 and older.

Despite the promising results, the study authors also noted that the effect of aspirin on incident type 2 diabetes among older adults remains uncertain.

“Given the increasing prevalence of type 2 diabetes among older adults, the potential for anti-inflammatory agents like aspirin to prevent type 2 diabetes or improve glucose levels needs further study,” the authors wrote.

“The earlier published trial findings from ASPREE in 2018 showed aspirin did not prolong healthy independent living but was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract,” Dr. Zoungas said.

“Major prescribing guidelines now recommend older adults take daily aspirin only when there is a medical reason to do so, such as after a heart attack.”

“Although these new findings are of interest, they do not change the clinical advice about aspirin use in older people at this time,” Dr. Zoungas added.

Dr. Jagdish Khubchandani, PhD, a professor of public health at New Mexico State University, expressed some concern about the study and told MNT the findings could give people the wrong idea.

“More than a third of the people in the U.S. are overweight, and a third are obese. The age of onset of [type 2] diabetes is most common in the range of 40 to 65 years. So, it is unclear how a study of adults more than 65 years of age will benefit the most at-risk population, even if we assume that the study findings are valid and reliable.”

— Dr. Jagdish Khubchandani, professor of public health

“A potential problem I see is people now taking aspirin without knowing the details of the study and understanding the risk of bleeding that accompanies aspirin consumption,” he said.

“As is, studies have shown that too many people are taking aspirin when they are not at risk or when they should not be taking it.

“While some studies have shown reduction in cardiovascular events — e.g., heart attacks — with aspirin consumption, many studies show no benefit or, on the contrary, higher risk of death. As of today, the latest U.S. government guidelines do not support aspirin use even for CV events,” Dr. Khubchandani said.

Dr. Pouya Shafipour, a family and obesity medicine physician at Providence Saint John’s Health Center in California, told MNT it’s long been known that low dose aspirin has strong, anti-inflammatory, and anti-platelet benefits.

“However, it really needs to be individualized as it increases the risk of bleeding, gastric ulcers, cerebral hemorrhage, and has other potential dangerous side effects,” Dr. Shafipour said.

“The risks in this case as a blanket statement significantly outweigh the benefits. Recommendations for a low-dose aspirin in the setting of someone with diabetes or other medical conditions that could potentially benefit, needs to be individualized and evaluated by, the physician who is familiar with the patient’s history and active conditions to ensure it does not increase risk of gastric ulcer, G.I. hemorrhage, or brain hemorrhage in addition to other side effects or drug interactions.”

— Dr. Pouya Shafipour, physician

“Elderly individuals are at higher risk of fall, which increases risk of potentially fatal brain hemorrhage,” Shafipour added. “It is no surprise that anti-inflammatory benefits of aspirin are important in preventing diabetes, but a healthy, low carbohydrate, Mediterranean diet, exercise, and improving eating behaviors could have similar or better benefits than added, low-dose aspirin.”

Dr. Raj Dasgupta, a specialist in internal medicine, pulmonary, critical care and sleep medicine and the chief medical advisor for Sleep Advisor, told MNT the study had its merits.

“The study has several strengths, including a large sample size and an extended follow-up period,” Dasgupta said.

“However, it also did not look at the effects of aspirin particularly looking at patients taking other medications that would put them at a higher risk for bleeding, or in patients with known gastrointestinal disorders, such as ulcers or gastritis.”

“It would be interesting to compare lifestyle modifications such as diet, exercise and sleep compared to just taking aspirin alone, in regards to developing type 2 diabetes. It would also be interesting to use hemoglobin A1c (HbA1c) as an endpoint in the study and not just fasting plasma glucose.”

— Dr. Raj Dasgupta, physician

Khubchandani noted that whether to take aspirin regularly includes various factors.

“The decision to start aspirin should be tailored to patients needs based on many factors, such as their risk of heart disease, lifestyles, tolerance for side effects, other chronic diseases like diabetes, just to name a few,” he said.