Indications for Aspirin 81mg Daily in Patients with Hypertension and Diabetes

Indications for Primary Prevention

The Canadian Diabetes Association recommends Aspirin 81mg daily for diabetic patients with hypertension who have established cardiovascular disease (secondary prevention) or who are at high cardiovascular risk (10-year risk >10%) with at least one additional risk factor, primarily among men >50 years and women >60 years 1, 2, 3
Aspirin 81mg is indicated for diabetic patients with hypertension who are at high cardiovascular risk (10-year risk >10%) and do not have a high risk of bleeding 2, 4
Men >50 years and women >60 years with diabetes and hypertension plus at least one additional risk factor (smoking, dyslipidemia, albuminuria, or family history of premature cardiovascular disease) are considered high risk 2, 3
For hypertensive patients aged ≥50 years with well-controlled blood pressure (<150/90 mmHg) and target organ damage, diabetes, or a 10-year cardiovascular risk ≥20%, daily Aspirin 81mg may be considered 5

All patients with established cardiovascular disease (secondary prevention) should receive Aspirin 81mg daily, unless contraindicated 1, 5, 6
For diabetic patients with a history of myocardial infarction or stroke, Aspirin is strongly recommended 6, 3
In cases of documented Aspirin allergy, clopidogrel (75 mg/day) should be used 3

The recommended dose is 81mg per day (low dose), which offers an optimal balance between efficacy and bleeding risk 1, 2
A dose of 75-162 mg/day seems optimal for cardiovascular prevention 1
The use of a proton pump inhibitor may be considered in patients at high risk of gastrointestinal bleeding, although its systematic use is not necessarily cost-effective 2, 4

The use of a cardiovascular risk assessment tool is essential to determine if Aspirin is indicated 2, 4
Several risk assessment tools are available, such as the QRISK risk calculator or the Framingham score 4, 7
Cardiovascular risk should be periodically reevaluated, as patients may acquire additional risk factors over time 2, 4

The decision to use Aspirin in primary prevention should be made in the context of shared decision-making, carefully weighing cardiovascular benefits against the comparable increase in bleeding risk 1
For diabetic patients with ischemic stroke or transient ischemic attack, short-term antiplatelet therapy combining Aspirin and clopidogrel (up to 21 days) may be protective without significantly increasing the risk of bleeding 6