Cardiovascular disease risk is extremely high in adults with diabetes. Yet women as well as people under 50 who have diabetes do not use aspirin, despite the fact that aspirin has been found an effective and inexpensive means to reduce risk of first and subsequent heart attack.
Previous research has demonstrated less frequent use of invasive cardiovascular procedures and effective medications for acute myocardial infarction, including thrombolytics, beta-blockers and aspirin, in women, compared with men.
"A similar disparity now exists for use of aspirin for primary and secondary cardiovascular disease prevention in diabetes," said Stephen D. Persell, M.D., and David W. Baker, M.D., researchers at Northwestern University Feinberg School of Medicine.
In a study in the Dec. 13/27 Archives of Internal Medicine, Persell, an instructor in medicine, and Baker, associate professor of medicine, assessed self-reported aspirin use among those over 35 with diabetes from 1997 to 2001.
It was in 1997 that the American Diabetes Association first recommended that aspirin be considered for prevention of cardiovascular disease events in any high-risk adult older than 30 years with diabetes.
Although their study found an encouraging increase in aspirin use in recent years among adults with diabetes, Persell and Baker noted a significant disparity in aspirin use between diabetic men and women that was not observed a decade earlier.
Among adults with diabetes without diagnosed cardiovascular disease, 42 percent of men and 34 percent of women used aspirin regularly. Younger and middle-aged adults used aspirin less frequently than did older adults.
Among those with diabetes and diagnosed cardiovascular disease, 83 percent of men and 65 percent of women reported regular aspirin use, and age was associated with lower aspirin use only among those young than 50 years.
There are several possible explanations for low use of aspirin among women, the researchers said.
Physicians may not counsel women with diabetes to use aspirin if the physicians underestimate the women's risk for cardiovascular disease events.
"However, even though women are at lower risk of new-onset cardiovascular disease than men, diabetes greatly reduces this female advantage," Persell said.
Physicians may have concerns that aspirin is less efficacious for women than men in primary prevention of cardiovascular disease events.
"Observational data suggest that aspirin prevents initial myocardial infarction in women, yet women were not well represented in early randomized trials of aspirin for the prevention of initial cardiovascular disease events," Baker said. The low use of aspirin associated with younger age is also noteworthy, the authors said.