Aspirin for primary prevention in patients with diabetes mellitus

Abstract

Background and objectives: Evidence supports the routine use of low-dose aspirin (ASA) in the prevention of cardiovascular (CV) events in patients with diabetes mellitus (DM). In 1997, the American Diabetes Association (ADA) recommended ASA prophylaxis for all diabetic patients over the age of 30 with one additional risk factor for cardiovascular disease (CVD). Our objective was to determine the adherence to the ADA guidelines for ASA therapy in DM using a national database.

Methods: Data from the 1997-2000 National Ambulatory Medical Care Survey (NAMCS) was used to determine the usage rates of ASA in patients with DM over age 30 years with one or more CV risk factors. Multiple logistic regression methods were used to determine what factors were related to ASA prophylaxis.

Results: During 1997-2000, more than one third of all diabetic patients should have been considered for ASA prophylaxis because they had one or more CV risk factors. Yet, from 1997-2000, the percentage of these patients given ASA for primary prevention was 2.8% in 1997, 2.9% in 1998, 2.1% in 1999, and 5.7% in 2000. Factors associated with increased ASA prophylaxis were non-white ethnicity, male gender, older age (more than 44 years old), rural clinic setting, preventative counseling given during visit, being prescribed more than two medications, having cardiovascular risk factors, and being seen by a cardiologist.

Conclusions: Adherence rates to the ADA standard of care guideline regarding routine ASA prophylaxis in adults with DM and at least one CV risk factor are extremely low. National efforts directed at increasing these rates of ASA prophylaxis are indicated to meet the Healthy People 2010 goal of 30%.