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Diabetes Update: Aspirin

Number 29; January 14, 2002

By David Mendosa

This newsletter keeps you up-to-date with new articles, columns, and Web pages that I have written. I list and link most of these on my Diabetes Directory at

From time to time Diabetes Update may also include links to other Web pages of special interest.

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    on January 12, 2002
  • How Much Aspirin Do You Take?
    It's been clear for years that taking a daily aspirin tablet would cut the risk of heart attack and stroke among people with diabetes if only we would take it. A year ago I reviewed the preliminary evidence for aspirin in my article for LXN Corp.'s "e-Charged Newsletter." Now we have, if not the final word, the results of an enormous body of research with some solid numbers.

    The January 12 issue of The British Medical Journal reported the meta-analysis of 287 studies of 135,000 people at high risk of heart attack or stroke. A meta-analysis is a combination of many different trial results designed to increase the reliability of research by combining and analyzing the results of all known trials of the same product or experiments on the same subject. The full text is free on-line at in PDF (Adobe Acrobat) format and at in HTML (browser) format.

    The clearest advance in our knowledge is the definitive finding that low doses of 75-150 mg daily are "at least as effective as higher daily doses." In the U.K. the low dose is typically 75 mg, while in the U.S. the low or baby aspirin dose is 81 mg.

    The meta-analysis also concluded that taking a low dose of aspirin reduced the risk of heart attack and stroke by about 25 percent—and that this applied not just to those who already had a heart attack but also to other high risk conditions, which they define as including diabetes. Furthermore, there is now good evidence that people with diabetes aren't at risk of any special side effects, such as bleeding in the eye.

    Nevertheless, fewer than one quarter of those people with diabetes who have a clear history of coronary artery disease regularly take aspirin. And only 7% of those without that history took it.

    Some people should avoid aspirin. Don't take it if you are taking another drug that interferes with clotting, such as warfarin (Coumadin), as I wrote in my original article. Consult your doctor before starting to take it regularly.

    A drug called clopidrogrel (Plavix) is the only other antiplatelet drug that has been compared with aspirin in large scale trials. The results from each drug are close. The study concluded that "clopidrogrel is an appropriate alternative for patients with a contraindication to aspirin." But clopidrogrel, which was released in 1998 following FDA approval, is not without problems. First, at $3 per pill it is 100 times the cost of aspirin, which is about 3¢ each. The side effects of clopidrogrel can also be more severe than those of aspirin.


  • The people at HealthTalk Interactive tell me that the next edition of Diabetes Forecast - Live! will be "What's Hot in New Diabetes Products." It will be on-line Tuesday, January 22, at In this edition, panelists endocrinologist Kenneth Gross of Virginia Mason in Seattle and founders of the online Diabetes Mall, Ruth Roberts, M.A., and John Walsh, P.A., C.D.E., will discuss the latest in diabetes management products. Topics will include new blood glucose meters, insulin delivery devices, medications, and consumer tips. You can submit questions in advance.


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