Aspirin therapy is still underutilized among patients with type 2 diabetes

Abstract

The daily use of aspirin in patients with type 2 diabetes mellitus (DM2) reduces significantly cardiovascular events (CVE). In the absence of contraindications, American Diabetes Association (ADA) recommends the use of aspirin to all DM2 patients older than 40 years of age. To evaluate aspirin use among 636 out patients with DM2 who participate in a regional multicenter study in Southern Brazil, a standard questionnaire was used. Patients also underwent a physical examination and laboratorial tests. All patients were older than 40 years (mean 58 +/- 11 years old; 42% male) and by ADA guidelines most of them should be using aspirin. However, only 177 (27.5%) were on this medication. The use of aspirin was higher when any CVE were present. However, the percentage of users was still below the expected, not even reaching 50%. In conclusion, even though the use of aspirin is greater in patients with CVE, and its benefits are well documented, it is still underutilized. Strategies to enhance the use of aspirin should be developed to reduce the morbidity and mortality from cardiovascular diseases in patients with DM2.

Utilização de ácido acetilsalicílico (AAS) na prevenção de doenças cardiovasculares: um estudo de base populacional

“…Estudos realizados entre 1999 e 2004 em países de alta renda (Estados Unidos, Islândia, Inglaterra), sobre o uso de AAS na prevenção de DCV, demonstraram prevalências muito amplas, variando entre 33% na prevenção primária até 97% na prevenção secundária 7,8,9,21 . No Brasil, um estudo realizado em 2005 na cidade de Porto Alegre avaliou 636 pacientes ambulatoriais, diabéticos, maiores de 40 anos com e sem DCV prévia e evidenciou que somente 17,7% dos pacientes estavam usando AAS na prevenção primária e 43% na prevenção secundária 10 . Não foram localizados estudos de base populacional que tenham avaliado a prevalência de uso de AAS na prevenção das DCV no Brasil.…”

“…No Brasil, existem poucos estudos para avaliar o uso de AAS, mas eles têm sido realizados em nível hospitalar ou ambulatorial, com frequências de uso de AAS de 17,7% no caso da prevenção primária e até 98% na prevenção secundária 10,11,12,13,14 . No entanto, não foram localizados estudos brasileiros de base populacional que tenham avaliado o uso de AAS para a prevenção primária ou secundária das DCV e nem os fatores que poderiam estar associados ao seu uso.…”

Prevention of Cardiovascular Disease in Diabetes Mellitus Outpatient: Focusing on Antiplatelet, Statins and Irrational Antihypertensive Drug Use

“…13 Penelitian lain juga menunjukkan hanya 175 dari 636 pasien DM yang diresepkan aspirin sebagai pencegahan primer dan sekunder penyakit kardiovaskular pada pasien DM. 14 Di Indonesia ditemukan satu penelitian di sebuah apotek di Surabaya, yang mana hasilnya menunjukkan obat penurun lipid tidak digunakan oleh 37,14% pasien DM, sementara aspirin tidak digunakan oleh: 1) 50,00% pasien DM berusia >50 tahun dengan atau tanpa penyakit kardiovaskular, dan 2) 75,00% pasien DM berusia <50 tahun dengan satu atau lebih penyakit kardiovaskular. 15,16 Dalam sebuah penelitian yang dilakukan pada masyarakat di India, juga ditemukan sebanyak 18 (7,20%) dari 250 pasien yang menderita DM dan hipertensi tidak mendapatkan agen antihipertensi.…”

“…Beberapa penelitian terdahulu juga menemukan penggunaan yang rendah dari aspirin dosis rendah pada pasien DM. 14,16 Suatu penelitian di pasien rawat jalan di Amerika Serikat menunjukkan adanya sedikit kenaikan pada tren penggunaan aspirin sejak tahun 2001 sampai dengan 2003. Terdapat berbagai faktor yang mempengaruhi penggunaan aspirin dosis rendah untuk pencegahan penyakit kardiovaskular pada konteks rawat jalan, antara lain risiko kardiovaskular, usia, jenis kelamin, spesialisasi dokter, waktu kontrol ke dokter, tempat praktek dokter, dan jumlah obat lain yang digunakan.…”

Anti‐platelets in diabetes management

“…6 Despite these recommendations, the use of antiplatelet therapy in both primary and secondary prevention among individuals with diabetes continues to be low, with reported figures ranging from 15% to 63%. [7][8][9][10][11] Reasons for poor compliance to the guidelines are unclear, but may include lack of recognition of the CVD risk associated with diabetes among physicians, 12 uncertainty over the benefits of aspirin for primary prevention, 13 concern over side-effects, and compliance challenges for patients on multiple drug therapies. 14 We sought to determine the rates of anti-platelet usage in a specialist diabetes centre, and the influence of contraindications or previous adverse effects on the use of anti-platelet therapy.…”