 Hey guys, this is Dr. Ahmed Ergen. I'm an endocrinologist and a diabetes educator. Now, if you don't know what an endocrinologist is, it is a person who treats hormone and particularly diabetes as the most common problem we deal with. Now, today we are talking about should a diabetic take aspirin. Now, if you didn't know, I'll tell you a quick statistic. And when I say statistics, it's a real information just to open your eyes. After age 65, the chances of a diabetic, the death, the cause of death for a diabetic, and I'm not trying to talk or scare you guys in any way, but just for you to understand the risk. After age 65, the cause of death for any diabetic after age 65 is 70% of the time is heart attack. And 16% of the time is stroke. What else left? I mean, almost 80, 85% of people die from heart attack or stroke. Now, the question is, should you take aspirin? Will aspirin reduce your risk of having a heart attack or stroke? So maybe it will have you live another 5, 10, 15 years? Will it? We'll see. Let's get started. So today, we are going to talk about what are the benefits of aspirin for a diabetic? What are the risks of aspirin? So if you think that aspirin has no risk, you're wrong. So we're going to talk about this risks of aspirin along with the benefits. And we are going to talk about the dosage. Do you need a baby aspirin? Do you need a 162? Do you need a 300? What do you exactly need for to prevent heart disease? And lastly, we are going to decide who is the ultimate candidate weighing the benefits versus the risk. All right? So I have looked at all the studies that looked at diabetics who are more than age 40. By the way, before age 40, there is no need to take aspirin at all. But let's say after age 40, when the studies looked at these people who are somewhat high risk, so you can be a diabetic, but that doesn't mean that you have high risk, right? So typically, when we look at these patients, on average, we see around 10 to 12% risk reduction. Now risk reduction is a relative thing. And a lot of my patients don't understand what the risk reduction is. But I think like this, the weather channel, right? So when you look at, you know, in Florida, when they say there's 30% chance of rain, we're like, ah, well, that's not going to rain. We don't really know that. But can it rain? Yeah, it can rain. That's what they say 30%. And but if they say 80% chance, I'm like, you know, maybe I should get prepared. And then, you know, when the risk goes down, that depends on how much risk you have. Let's say you look at the weather channel, they say 80% risk. And the next day, they say 70% risk, you're like, oh, well, that's too pretty high, you know, like, you know, it didn't make a big difference. But if it goes on to 30%, then you're like, oh, yeah, things change. Now with a rather risk reduction, what I'm trying to say here is the risk reduction based on your initial risk. So if your risk to die from a heart attack is higher, then 10% risk reduction is pretty good. That means that we are saving, you know, 10 out of 100 people from dying from having a heart attack. But if you don't have that risk, you know, then you don't have to worry about that. Now, what are the risks really? How do you know that you're high risk? Now, number one, if you have a high blood pressure along with your diabetes, you are at high risk. And the higher the blood pressure, the higher the risk. So there is actually a calculator that you can calculate based on all those factors that I'm going to tell you, you can put it put it down in a calculator. And, and it will tell you what your exact risk is. Now, there is the calculator that I'm going to put down in the link in the description below is going to have basically a framing of risk score, which did not include diabetes. But there are some medical sources that I cannot provide you the link, because these are paid sources, unless you pay for it, you don't unfortunately get that believe it or not, I'm paying a few thousand dollars to get some of the information that I'm getting from those resources. Unfortunately, most of patients don't have access to, and I hope these videos will be helping you guys. What I'm trying to say is that link will take you to a risk factor that doesn't calculate the diabetic risk. But typically, what happens is that you have to double that risk. If your risk is 10% on that risk calculator, then you're looking for a 20% risk overall. So you can, you know, it typically on those other links that I go to, a few experiments. And I know that the diabetes increases your risk by two to four times. But in that risk calculator, it's typically, you know, it comes out to be like twice the higher risk when you include the diabetes to the risk factor. So check that out. Another risk factor is basically high blood pressure, high cholesterol, especially low HDL. If your total cholesterol over HDL ratio is high, that means that you have a low HDL and high total cholesterol than that puts you at risk. And what else smoking? That's no brainer. There's no question there. And if you have albuminuria, which means that albuminuria is like your, your kidney is leaking protein, your doctors will test you once a year or so. If you, if you have been positive, they may test you more often. But if you have protein in your urine, basically, that can put you at risk. If you have chronic kidney disease already, that's also considered risk. And then if you have a family history of cardiovascular disease, like, not like if your father, you know, had a heart attack at 80, that's not really a risk, you know, that's, that's almost inevitable. Sometimes that's not a premature disease. But what I'm saying here is a heart attack like in somebody in your family in their 50s or, you know, early 50s or so can be a risk. If it is before 50, that's even a bigger risk factor. So risks of aspirin use, right? So there are definitely risks. What are the risks? I can't, I think you can imagine that it's bleeding. So we call, we consider them divide into two, extra acrenial and intra acrenial. Intra acrenial, acrenial means head. Basically, if you have, you may have a hemorrhagic stroke, which means that bleeding into your brain, and that's not good. Thankfully, it does not happen too often. Generally, one in 10,000 people take aspirin, who take aspirin can get that. But most common is the gastrointestinal, which is your bowel bleeding. So that is fairly common, especially the older you are, the higher the risk of having a peptic ulcer disease. And if you already have a peptic ulcer disease, you should definitely be super careful. If you are taking like NSAIDs like ibuprofen or some other painkillers, like in the NSAID group, can definitely increase your risk even more. So you have to be careful. So if you have either risk factors for a potential gastrointestinal bleeding, especially if you had a bleeding before, like a gastrointestinal bleeding, then you have to be really careful about that because I have seen people dying from gastrointestinal bleeding. It's not just a minor thing, especially if you're older, it can put you in a severe anemia. If it is bleeding is severe enough, you may need transfusion. I see you admissions, but I was a resident, I had to deal with that all the time. So increased risk is typically a relative risk, around 50%. So compared to risk reduction with the modest reduction with the aspirin, risk appears to be a little high. What do you think? Put your comments down and let me know what you think. Now we're going to talk about the next. What is the optimal dose for aspirin then, right? How much aspirin do you really need? Do you need this 75 milligram? Do you need 162 milligram? Do you need 1500 milligram? Well, if you're going to really suicide, no, you really need 75 milligram. The studies show that the difference between 75 milligram or higher doses was not any different for any benefit. The benefit was the same. So do not overdose on aspirin. What is the verdicts? Who should take aspirin then? Here is my verdict. After hearing all this, I will tell you this and that's the common recommendation based on the studies and meta-analysis and so forth. If you are a person with diabetes who are at high risk, what is the high risk? I'll tell you that actually it's more than 10% of risk based on the calculation that I provided the link below. If you have more than 10% risk, now by the way, remember to double that risk that you are finding in that link because that link does not consider the diabetes as a risk factor. It's designed for non-diabetics, but diabetics typically have twice the risk factor as we discussed. So if you're finding yourself at 6% on that and then you're diabetic, that means that you are 12%. So if 12% risk and you do not have other contraindications for risk of bleeding, now you may not decide on that, right? So you may still want to talk to your doctor, have a discussion, hey, you know, doc, do I need to be concerned about bleeding? What are my risk factors? If you and your doctor thinks that your risk is more for heart attack than the bleeding, then you may consider that. But still, if you have an active paptic ulcer, you're on a bunch of ibuprofen or other NSAIDs, you may have to take that with granus salt because the benefit is modest. But if you have a lot of risk factors, like we discussed, high blood pressure, high cholesterol, smoking, chronic kidney disease, family history of heart disease, etc., etc., then taking aspirin will definitely reduce the risk. Now there are other risk reduction measures like keeping your LDL down, keeping your HDL up, you know, eating healthy, etc., Mediterranean diet, which we all have videos about. But definitely when it comes to aspirin, that is my final verdict. So you guys, if you liked this video, remember to give it a thumbs up and remember to subscribe and share it with family and friends. That's an important topic and everybody needs to know. Have a wonderful day.