In light of the heightened risk of bleeding in elderly individuals, current prescription guidelines recommend that older adults should only use daily aspirin for specific medical purposes, such as post-heart attack care. However, fresh research set to be unveiled at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (October 2-6) indicates that administering a daily dose of 100mg of aspirin may potentially reduce the chances of developing type 2 diabetes by 15% in individuals aged 65 or older.
The study’s lead author, Professor Sophia Zoungas from the School of Public Health and Preventive Medicine at Monash University in Melbourne, Australia, underscores the significance of these findings, stressing the need for a more profound exploration of the role of anti-inflammatory agents like aspirin in diabetes prevention.
Uncertainty surrounds the impact of aspirin on the occurrence of type 2 diabetes in older adults. This study delves into the randomized treatment effects of low-dose aspirin on incident diabetes and fasting plasma glucose (FPG) levels in the elderly. The researchers conducted a follow-up investigation based on the ASPREE trial, a double-blind, placebo-controlled aspirin trial whose primary results were published in NEJM in 2018. The original study revealed that aspirin use led to a 38% increase in the risk of major hemorrhages in older adults without a concurrent reduction in cardiovascular disease incidence.
The study recruited community-dwelling individuals aged 65 and above who were free from cardiovascular disease, physical disabilities that limit independence, and dementia. Participants were randomly assigned to receive either 100 mg of daily aspirin or a placebo. Incident diabetes was defined as self-reported diabetes, the initiation of glucose-lowering medication, and/or a fasting plasma glucose (FPG) level of 7.0 mmol/L or higher during annual follow-up visits. Individuals with pre-existing diabetes were excluded from the study. Computer modeling and statistical analysis were employed to assess the effects of aspirin on incident diabetes and FPG levels, respectively.
The analysis encompassed a total of 16,209 participants, with 8,086 receiving aspirin and 8,123 receiving a placebo. Over a median follow-up period of 4.7 years, 995 new cases of diabetes were recorded (459 in the aspirin group and 536 in the placebo group). In comparison to the placebo group, the aspirin group exhibited a 15% reduction in incident diabetes and a slower rate of FPG increase (annual FPG change difference: -0.006 mmol/L).
The authors state: “Aspirin treatment reduced the occurrence of new diabetes cases and decelerated the rise in fasting plasma glucose among initially healthy older adults. Given the increasing prevalence of type 2 diabetes in this age group, further research is needed to explore the potential of anti-inflammatory agents like aspirin in preventing type 2 diabetes or improving glucose levels.”
Nevertheless, Professor Zoungas adds a note of caution: “The previously published trial findings from ASPREE in 2018 indicated that aspirin did not extend healthy, independent living but was associated with a significantly higher risk of bleeding, primarily in the gastrointestinal tract. Therefore, major prescribing guidelines currently recommend that older adults should use daily aspirin only when there is a specific medical indication, such as following a heart attack.”
“These intriguing new findings, while noteworthy, do not alter the clinical guidance regarding aspirin use in older individuals at this time.”
Event: Annual Meeting of the European Association for the Study of Diabetes (EASD)