Aspirin therapy does not protect diabetics from first heart attack

Pennies from Heaven

You’ll never guess who’s selling a phytosterol supplement.

Quick note on phytosterols – they’re natural plant sterols that just happen to block absorption of dietary cholesterol. Wheat germ, nuts, seeds (especially sesame), and vegetable oils all contain phytosterols.

Phytosterol supplements are nothing new, but this IS new: Bayer recently introduced a product called Heart Advantage, which contains 400 mg of phytosterols. Unfortunately, Heart Advantage also contains 81 mg of aspirin.

Too bad. They’d actually have a safe and useful product there if it were JUST the phytosterols.

Busting a myth

If you have type 2 diabetes and your doctor has recommended you take a daily low-dose aspirin in the wildly optimistic belief that this reduces heart attack risk, ask him to pull down a recent issue of the British Medical Journal.

There he’ll find a study that won’t put an end to the common “heart health” advice to take an aspirin every day – but it absolutely should.

Researchers at Scotland’s University of Dundee recruited more than 1,270 subjects with either type 1 or type 2 diabetes. Each subject was also diagnosed with peripheral arterial disease (reduced blood flow to the legs).

Subjects were divided into four groups to receive two capsules daily:

Group one: 100 mg aspirin and an antioxidant supplement
Group tw 100 mg aspirin and placebo
Group three: Antioxidant supplement and placebo
Group four: Two placebos

Results: After eight full years of intervention, neither the aspirin nor the antioxidant supplements had any effect at all on rates of heart attack or stroke compared to placebo.

Inert, or maybe a little bit ert?

Although antioxidants are proven to be good for your heart, I’m not going to claim that taking antioxidants supplements will actually prevent heart attack and stroke. Nevertheless, it should be noted that the supplements used in this study contained a ridiculously low dose of vitamin C (100 mg per day), and the vitamin E form was alpha tocopherol, not the more effective mixed tocopherol form.

Also – here’s an odd wrinkle: Aspirin (like all NSAIDs) prompts gastrointestinal bleeding. It’s the primary adverse event linked to this drug. And yet, more people in the placebo/placebo group experienced GI bleeding than in either of the aspirin groups. In addition, there were nearly 60 reports of general GI reactions in the placebo/placebo group, but only 40 in the aspirin/placebo group.

So…what the heck was in those placebos? (Bayer provided the aspirin used in the study and the “aspirin” placebo.)

The authors of the study insist that aspirin therapy is still a terrific idea for people who have already had a heart attack or a stroke. But before you sign on with that “conventional wisdom” you can find more information about GI bleeding and other adverse side effects linked to daily aspirin intake in the e-Alert “Misuse Only As Directed” (5/22/08).

Source:
“The prevention of Progression of Arterial Disease and Diabetes (POPADAD) Trial: Factorial Randomised Placebo Controlled Trial of Aspirin and Antioxidants in Patients with Diabetes and Asymptomatic Peripheral Arterial Disease” British Medical Journal, Vol. 337, 10/16/08, bmj.com