Diabetes aspirin use questioned

Aspirin makes it harder for blood clots to form
Aspirin should not routinely be used to prevent heart attacks in people with diabetes, Scottish research suggests.

The British Medical Journal reported that in 1,300 adults with no symptoms of heart disease the drug, which can cause stomach bleeds, had no benefit.

The findings contradict many guidelines which advocate people with diabetes use aspirin to counter the underlying high risk of heart attack and stroke.

But there are key high-risk groups who still need the drug, experts said.
Patients with concerns are advised to consult their GP before changing medication.
In people who have already had a heart attack or stroke, or have been diagnosed with coronary artery disease, aspirin has been shown to reduce the risk of future "events" by around 25%.

However, in recent years doctors have begun to focus on people who have not yet developed so-called cardiovascular disease, but are at high-risk of having it in the future - such as people with diabetes.
There are around two million people over 40 with diabetes in the UK.
Around 80% of people with diabetes die of cardiovascular disease including strokes and heart attacks.
A daily dose of aspirin is recommended by several UK guidelines as a "preventive" treatment in these groups.

No benefit
But in the latest study in adults over 40 years with type 1 or type 2 diabetes and no symptoms of cardiovascular disease, there was no difference over seven years in heart attacks or strokes between those given aspirin and those given a dummy pill.

ASPIRIN USE
It can reduce the risk of people who have had strokes or heart attacks being ill again
But this study shows no benefit for people with diabetes who have no signs of heart disease
There is a known risk that taking the drug can cause stomach bleeds
People should talk to their GP before they stop taking the drug

Study leader Professor Jill Belch, from the University of Dundee, said aspirin was one of the most common causes of hospital admission for gastrointestinal bleeding.
"We have got a bit ahead of ourselves with aspirin.
"We need to think again about using it for primary prevention."
However she stressed the drug was beneficial in people who had already had a heart attack or stroke.

Professor Peter Sever, an expert in clinical pharmacology and therapeutics at Imperial College London, said the study was "extremely important".
"It confirms many concerns we have that aspirin is very widely used in the general population without an evidence base to support its overall benefits.
"Thousands of people buy aspirin over the counter - I'm forever saying to patients you shouldn't be taking this.
"I have had a couple of patients admitted to hospital with major gastrointestinal bleeding when there was no evidence it was doing any good."

The number of people diagnosed with diabetes and as having a high risk of cardiovascular disease is set to increase, with government plans in England to introduce a national screening programme for the over-40s next year.
Professor Steve Field, chair of the Royal College of GPs, said it would be worth revisiting the guidelines.
"But patients shouldn't panic or stop taking aspirin," he said.

Judy O'Sullivan, cardiac nurse at the British Heart Foundation, said: "This study adds weight to the evidence that aspirin should not be prescribed to prevent disease of the heart and circulation to people with diabetes, and other high risk groups, who do not already have symptoms of the disease."

Fatty acids clue to Alzheimer's

Scientists want to know more about the brain changes that lead to Alzheimer's

Controlling the level of a fatty acid in the brain could help treat Alzheimer's disease, an American study has suggested.
Tests on mice showed that reducing excess levels of the acid lessened animals' memory problems and behavioural changes.
Writing in Nature Neuroscience, the team said fatty acid levels could be controlled through diet or drugs.
A UK Alzheimer's expert called the work "robust and exciting".

There are currently 700,000 people living with dementia in the UK, but that number is forecast to double within a generation.

Over-stimulation
Scientists from Gladstone Institute of Neurological Disease and the University of California looked at fatty acids in the brains of normal mice and compared them with those in mice genetically engineered to have an Alzheimer's-like condition.
They identified raised levels of a fatty acid called arachidonic acid in the brains of the Alzheimer's mice.

This is cause for cautious optimism, as fatty acid levels can be controlled to some extent by diet and drugs
Rebecca Wood, Alzheimer's Research Trust

Its release is controlled by the PLA2 enzyme.
The scientists again used genetic engineering to lower PLA2 levels in the animals, and found that even a partial reduction halted memory deterioration and other impairments.

Dr Rene Sanchez-Mejia, who worked on the study, said: "The most striking change we discovered in the Alzheimer's mice was an increase in arachidonic acid and related metabolites [products] in the hippocampus, a memory centre that is affected early and severely by Alzheimer's disease."

He suggested too much arachidonic acid might over-stimulate brain cells, and that lowering levels allowed them to function normally.

Dr Lennart Mucke, who led the research, added: "In general, fatty acid levels can be regulated by diet or drugs.
"Our results have important therapeutic implications because they suggest that inhibition of PLA2 activity might help prevent neurological impairments in Alzheimer's disease.

"But a lot more work needs to be done before this novel therapeutic strategy can be tested on humans."
'Cautious optimism'

Rebecca Wood, chief executive of the UK's Alzheimer's Research Trust, said: "This research on mice suggests a connection between fatty acids and the abnormal brain activity that exists in Alzheimer's disease.
"This is cause for cautious optimism, as fatty acid levels can be controlled to some extent by diet and drugs.
"However, it is not yet clear if these findings are applicable to humans, and a lot more research is needed before any human trials can be conducted."

Professor Clive Ballard, director of Research at the Alzheimer's Society, said the work was "robust and exciting".
He added: "This is a novel and potentially exciting area of research, but it is still at a very early stage.
"Much more research is needed to see if fatty acids could lead to a treatment for those living with the devastating effects of Alzheimer's disease."