Low-dose aspirin linked to lower type 2 diabetes risk in older adults.

Low-dose aspirin linked to lower type 2 diabetes risk in older adults.

Daily Low-Dose Aspirin and its Potential Benefits in Elderly Adults

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Experts say the benefits of daily low-dose aspirin may not outweigh the concerns over its use in older adults. However, a new study has found that low-dose aspirin could potentially lower the risk of type 2 diabetes in people over 65. While earlier studies have indicated that regular use of low-dose aspirin can cause bleeding, the new study makes good points about its potential benefits. However, doctors not involved with the study highlight the complexity of the issue and suggest that regular aspirin use may not be entirely safe.

The study, which will be presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany, followed up on the ASPREE trial. The ASPREE trial was a double-blind, placebo-controlled trial of aspirin that concluded in 2018, revealing that aspirin conferred a 38% increased risk of major hemorrhage in older adults without any reduction in incidence of cardiovascular disease.

In this new study, researchers led by Professor Sophia Zoungas from Monash University in Melbourne, Australia, discovered that using a low dose of aspirin (100 mg daily) among adults aged 65 and older is associated with a 15% lower risk of developing type 2 diabetes. The researchers suggested that further study is needed to examine the potential of anti-inflammatory agents like aspirin in the prevention of diabetes.

To conduct the study, the researchers looked at community-dwelling individuals aged 65 or over, who were free of cardiovascular disease, independence-limiting physical disability, and dementia. Participants were randomized to either receive 100 mg of daily aspirin or a placebo. The study investigated the randomized treatment effect of low-dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels among older adults. Incident diabetes was defined 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.

The analysis included 16,209 participants, with 8,086 randomized to the aspirin group and 8,123 to the placebo group. Over a median follow-up of 4.7 years, there were 995 incident diabetes cases, with 459 in the aspirin group and 536 in the placebo group. Compared to the placebo group, the aspirin group had a 15% reduction in incident diabetes and a slower rate of increase in fasting plasma glucose. The authors concluded that “aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults.”

However, it’s essential to note that despite these findings, medical professionals caution against widespread aspirin use in older adults. Professor Zoungas stated that while the new study’s findings are of interest, they do not change the clinical advice about aspirin use in older people. Previous trial findings have shown that aspirin did not prolong healthy independent living and was associated with an increased risk of bleeding, primarily in the gastrointestinal tract. As a result, major prescribing guidelines now recommend that older adults take daily aspirin only when there is a specific medical reason, such as after a heart attack.

Reaction to the study has been mixed. Professor Jagdish Khubchandani from New Mexico State University expressed concerns about the study. He argued that targeting adults over 65 may not benefit the most at-risk population, considering that the age of onset of type 2 diabetes is most common between 40 to 65 years. Additionally, there is a potential risk of people taking aspirin without fully understanding the risk of bleeding that accompanies its consumption. Some studies have shown a reduction in cardiovascular events with aspirin consumption, while others show no benefit or even a higher risk of death. Currently, the latest U.S. government guidelines do not support aspirin use, even for cardiovascular events.

On the other hand, other medical professionals see the merits of the study. Dr. Pouya Shafipour, a family and obesity medicine physician at Providence Saint John’s Health Center in California, acknowledged that low-dose aspirin has strong anti-inflammatory and anti-platelet benefits. However, he emphasized the need for individualized recommendations, as aspirin increases the risk of bleeding, gastric ulcers, cerebral hemorrhage, and other potential dangerous side effects. In his opinion, the risks of aspirin use outweigh the benefits, and other lifestyle modifications, such as adopting a healthy, low-carbohydrate Mediterranean diet, exercise, and improving eating behaviors, may have similar or better benefits than low-dose aspirin.

Dr. Raj Dasgupta, a specialist in internal medicine, pulmonary, critical care, and sleep medicine, also found the study to be valuable. However, he pointed out that the study did not consider the effects of aspirin in patients taking other medications that increase bleeding risk or those with known gastrointestinal disorders. He also suggested that comparing lifestyle modifications with aspirin use alone in terms of developing type 2 diabetes would be interesting, as well as using hemoglobin A1c (HbA1c) as an endpoint.

In conclusion, while the new study suggests potential benefits of low-dose aspirin in reducing the risk of type 2 diabetes among older adults, medical professionals emphasize the need for individualized recommendations. Considering the associated risks of bleeding and other adverse effects, aspirin should only be used when there is a clear medical reason. Lifestyle modifications, such as a healthy diet and regular exercise, remain crucial for preventing and managing type 2 diabetes. As further research is needed to fully understand the impact of aspirin in this context, it is essential to consult with healthcare professionals before considering aspirin as a preventive measure.