Past Feature Article

Getting to the Heart of Diabetes

By: Dani Dolin, Rite Aid Pharmacist and Diabetes Care Specialist in Kingwood, West Virginia

People with diabetes often focus on watching carbohydrates, limiting sugar, and trying to balance meals. And while nutrition is an extremely important part of managing your diabetes, protecting your heart deserves equal emphasis. Heart disease is the number one cause of death in America; strokes are number three. Two out of every three people with diabetes die from heart disease or a stroke1. So put your food labels down, and take a minute to listen to your heart.

What is CVD?

Cardiovascular disease (CVD) is a general term for diseases of the heart and blood vessels². It is estimated that 1 in 4 people have some sort of CVD, and that one person dies every 33 seconds from CVD. High blood pressure, high cholesterol, diabetes, tobacco use, physical inactivity, poor nutrition, and being overweight increase your risk of this disease. While CVD is affecting America as a whole, your risk, as a person with diabetes, is increased 2-4 times. In fact, your risk of having a heart attack is the same as a person without diabetes who has already had a heart attack¹.

What is heart disease?

Heart disease, sometimes called coronary heart disease or CHD, occurs when the blood vessels that supply the heart with blood, oxygen, and nutrients become thinner than normal. When the arteries are damaged or clogged with fat or other material, the arteries become smaller, like a clogged drain. The blood vessels cannot give the heart enough oxygen, so chest pain may occur. If a clot forms and blocks blood flow to the heart, a heart attack may result. Strokes take place when blood flow to the brain is blocked³.

What can you do to reduce your risk of heart disease or prevent future cardiovascular events?

Experts agree that people with diabetes over the age of 30 years should take low-dose enteric-coated aspirin everyday.

How does aspirin help?

The bodies of people with diabetes tend to produce more of a chemical called thromboxane. Thromboxane causes blood vessels to narrow and platelets to clump. Smaller blood vessels combined with clumps of blood platelets can cause blood clots, leading to strokes and heart attacks. Aspirin is thought to block thromboxane³.

Show me the data

Much research has been done with aspirin and CVD. Some of this research is targeted at primary prevention- preventing the first heart attack, stroke, or other form of CVD from ever occurring. One study showed that aspirin therapy decreased CVD events by 15% and heart attacks by 36%⁴. Other research is aimed at secondary prevention- preventing additional CVD events from happening. One group of researchers looked at 145 different studies on secondary prevention. The risk of CVD events decreased by approximately 25%. They also found that for every 1000 people with diabetes, between 22 and 50 vascular events could be prevented if the patients take a daily aspirin⁵. When combining data from primary and secondary studies, aspirin therapy lowers the risk of heart attacks by 17-44%, strokes by 25%, and CVD death by 5-17% in patients with diabetes⁶.

Aspirin for all?

So shouldn't everyone take an aspirin a day? If you have an allergy to aspirin, digestive tract bleeding, stomach ulcers, active liver disease, uncontrolled high blood pressure, hemorrhagic stroke, a bleeding tendency, or if you are on blood thinners, aspirin therapy may not be right for you. It is especially important that you and your doctor talk about aspirin together. The use of aspirin is not recommended in people under the age of 21 because of the risk of Reye's syndrome. In fact, the effects of aspirin haven't even been studied in people under the age of 303. While many people with and without diabetes can benefit from aspirin, it is still a decision that should be discussed with your health care professional.

A hearty dose of aspirin?

If there is such a strong link between cardiovascular disease and diabetes, you should take a big dose of aspirin- right? Wrong! Studies show that you get just as much protection from a low dose 81mg baby aspirin as you do with a 325mg regular strength aspirin. The larger dose of aspirin you take, the more risk you have of side effects like stomach irritation, nausea, vomiting, and bleeding. Unless your healthcare provider tells you otherwise, it is recommended that you take a low dose baby aspirin. In this case, more is not better.

Make your heart happy

Aspirin is not only good for your heart and your vessels, but it's easy on your wallet. Whether you choose a name brand such as St. Joseph's or Bayer aspirin or you opt for the less expensive Rite Aid aspirin, you will receive a potentially life-saving medication at a very low cost. But the pill can only do so much. You need to keep reading your food labels, eat a healthy well-balanced diet, exercise regularly, and monitor your blood sugar to make your heart and whole-self truly well.

References

Center for Disease Control. http://www.cdc.gov/nccdphp/ aag/aag_cvd.htm. Updated 8/4/04. Accessed 8/15/04.
Mayo Clinic. http://www.mayoclinic.com/invoke.cfm?id=HB00032. Updated 8/5/04. Accessed 8/15/04.
Davidson MB. Aspirin therapy in diabetes. Diabetes Care. 21: S72- S73; 2004)
Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S. Effects of intensive blood pressure lowering and low dose aspirin on patients with hypertension: principal results of the Hypertension Optimal Treatment randomized trial. Lancet. 351:1755-1762; 1998.