Primary Prevention of Cardiovascular Events With Aspirin in Patients With Diabetes

Although aspirin is one of our oldest pharmacological agents and much is known about it, our understanding of the particulars of its use as a preventive measure for cardiovascular disease (CVD) still resides in the domain of debate. Clearly, aspirin does offer some benefit in reducing the risk of CVD, but questions remain regarding the choice of patients and the optimal dose.Patients with diabetes comprise a special population and are often prescribed aspirin for its potential cardiovascular risk-reductive action. This brief article reviews the use of aspirin in this population as a primary preventive measure. It focuses on several recently released position statements, including one recently co-issued by the American Diabetes Association (ADA), the American Heart Association (AHA), and the American College of Cardiology Foundation (ACCF).Salicin, a natural precursor of aspirin found in willow bark and leaves, was used during the time of Hippocrates (400 BC) for the attenuation of pain and as an anti-pyretic.1 In the 1800s, aspirin was synthesized from the spirea plant (which is rich in salicin), and by 1899, the Bayer pharmaceutical company was distributing aspirin to physicians for use in their patients.Aspirin was typically used for the management of pain, fever, and inflammation, but in 1948, Dr. Lawrence Craven, using only his intuition and empirical observations, noted that his patients treated with aspirin did not suffer heart attacks. Based on this notion, he routinely prescribed aspirin to his patients as a preventive measure.2 Ironically, in 1957, Craven died at the age of 74 of a myocardial infarction (MI), while denying himself aspirin therapy because he fell out of the age range that he felt benefited from treatment (45–65 years). It is interesting to note that his initial recommendations were fairly consistent with today's data-based recommendations.The elucidation of aspirin's mechanisms …