Fast Five Quiz: Type 2 Diabetes and Coronary Heart Disease

Romesh Khardori, MD, PhD


April 24, 2023

Antiplatelet therapy is important for reducing cardiovascular risk in certain patients with type 2 diabetes. In patients who have experienced an acute coronary syndrome, combination antiplatelet therapy using a P2Y12 receptor antagonist in combination with low-dose aspirin is reasonable for at least 1 year and may have benefits beyond this period.

A higher incidence of major bleeding, including intracranial hemorrhage, has been noted with dual antiplatelet therapy; clinicians should carefully weigh the risk-benefit ratio with their patients when selecting antiplatelet therapy.

Antiplatelet therapy has been shown to be effective for reducing cardiovascular risk in patients with type 2 diabetes. For example, in the randomized ASCEND trial (N = 15,480), there was a significant 12% reduction in cardiovascular events with daily aspirin 100 mg compared with placebo. However, major bleeding was significantly increased from 3.2% to 4.1% in the aspirin group (rate ratio, 1.29; P = .003); most of the bleeding was gastrointestinal bleeding. Hence, the use of aspirin for primary prevention needs to be carefully considered and is generally not recommended, especially in older adults. For patients with documented atherosclerotic cardiovascular disease, the use of aspirin for secondary prevention has more benefit than risk and is recommended; clopidogrel may be an option for patients with aspirin hypersensitivity or intolerance.

Learn more about improving outcomes in patients with type 2 diabetes.

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