Diabetes mellitus is a chronic condition characterized by hyperglycemia as a result of a person being unable to control their blood glucose. There are three types, one which occurs during pregnancy known as gestational diabetes and then type one and type two diabetes (Ignatavicius & Workman, 2016). This paper will be focused around type one and type two. Both conditions result in the inability of a person to move glucose form their blood into their cells, resulting in hyperglycemia (Porth, 2015). Poor long term control of blood sugar as a result of diabetes has severe consequences on the vascular system including; retinopathy, nephropathy, peripheral vascular disease, stroke, and coronary artery disease (WHF, 2016).

Cardiovascular disease is the leading cause of mortality in people with diabetes (WHF, 2016) There are multiple risk factors for macrovascular disease found in people with diabetes including; obesity, hypertension, hyperglycemia, hyperinsulemia, hyperlipidemia, altered platelet function, endothelial dysfunction, systemic inflammation, and elevated fibrinogen levels (Porth, 2015). Typically, in people with type one the duration and onset occurs later in life while, people with type two diabetes show these manifestations around the time of their diagnosis (Porth, 2015). According to the American Heart Association (AHA, 2017) adults with diabetes are two to four times more likely to die from some type of heart disease than those who do not have it. In diabetic patients over the age of 65, 68% of diabetic patients die from coronary heart disease while 16% of them die from a stroke (WHF, 2016).

Platelets in both men and women diagnosed with diabetes are hypersensitive due to an increased in the release of thromboxane, a vasoconstrictor and platelet aggregant (Kirkman, 2010). Researchers have found an excess release of thromboxane in people with type two diabetes leading to enhanced platelet aggregation (Kirkman, 2010). This increased clotting puts these patients at a much higher risk for a cardiovascular event compared to people are not diabetic. Antiplatelet drugs have been used to help prevent and lower the chances of these cardiovascular events (Kirkman, 2010). When searching the use of antiplatelet drugs in diabetic patients it appeared that aspirin was the most widely studied. The action of aspirin has been shown to block the synthesis of thromboxane by acetylating platelet cyclooxygenase in both diabetic and non-diabetic patients (Kirkman, 2010).

It is important that healthcare professionals stay up to date in their field. This is where evidenced based practice comes into play. The purpose of evidenced based practice is to improve care processes and health outcomes in patients (Fain, 2013). This paper focuses on using aspirin as both primary and secondary prevention of cardiovascular disease in patients with diabetes. I will start by discussing the current recommendations from the American Diabetes Association and from there I will develop a question using the PICO format. I will then search different research articles and studies using different databases and keywords. A literature review will be conducted on the acquired materials to analyze whether the evidence supports or refutes current recommendations.

Current Recommendation

The effect of aspirin for the prevention of cardiovascular disease in adults who have diabetes is still unclear, but several trials suggest that aspirin can reduce the risk of cardiovascular events (Kirkman, 2010). The American Heart Association (AHA) and American Diabetes Association (ADA) jointly recommend that low dose aspirin (75 – 161 mg per day) should be used for adults who have diabetes, no previous history of vascular disease who but are at an increased risk of cardiovascular disease, and who are not at increased risk for bleeding. Risk reduction has been found to be as effective at lower doses when compared to higher doses (500 – 1,500 mg per day). (Kirkman 2010). Factors that put you at higher risk of cardiovascular events with diabetes are age (men over 50 and women over 60) and a history of the following; smoking, hypertension, dyslipidemia, family history of cardiovascular disease, and high levels of albumin in the urine (Kirkman, 2010). People who classified as at an increased risk of bleeding are those who have had previous gastrointestinal bleeding, peptic ulcer disease, or who currently use medications that increase bleeding risk (warfarin or NSAIDS) (Kirkman, 2010).

Clinical Question

Referencing the recommendation provided by the AHA and ADA the question that I would like to further look into is: In patients with diabetes, does taking aspirin daily reduce the risk of future cardiovascular disease compared to diabetic patients who do not take aspirin daily?

Integrated Literature Review

A literature review uses both identification and analysis of publications related to the research problem at hand (Fain, 2013). When doing a literature review the main pur