Due to the potential for bleeding in older individuals, current prescribing guidelines suggest that elderly adults should only take daily aspirin for specific medical reasons, like following a heart attack.
New research to be presented at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (2-6 October) reveals that administering a daily dose of 100mg of aspirin can potentially reduce the risk of type 2 diabetes by 15% in individuals who are 65 years of age or older.
The authors, led by Professor Sophia Zoungas, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, emphasize that these findings highlight the need for deeper exploration into the role of anti-inflammatory agents like aspirin in diabetes prevention.
The effect of aspirin on incident type 2 diabetes among older adults remains uncertain. This study investigated the randomized treatment effect of low-dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels among older adults. 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 NEJM in 2018. The original study showed that aspirin conferred a 38% increased risk of major hemorrhage in older adults without any reduction in the incidence of cardiovascular disease.
The study enrolled community-dwelling individuals aged 65 years or over, and free of cardiovascular disease, independence-limiting physical disability, and dementia. Participants were randomized 1:1 to 100 mg daily aspirin or placebo. Incident diabetes was defined as a self-report of diabetes, the 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. Patients with diabetes at the start of the study were excluded. Computer and statistical modeling assessed the effect of aspirin on incident diabetes and FPG levels respectively.
A total of 16,209 participants were included in the analysis (8,086 randomized to aspirin and 8,123 to placebo). Over 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).
The authors say: “Aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults. 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.”
However, Professor Zoungas adds: “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. 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.”
Meeting: Annual Meeting of the European Association for the Study of Diabetes (EASD)