Introduction
On the basis of the PICOT question that establishes the process of research and facilitates the development of its results the study dedicated to the impact and safety of low-dose aspirin for the prevention of cardiovascular events in patients with diabetes was conducted. This work identifies the practice issue related to diabetes treatment, formulates the PICOT question, summarizes the findings of multiple researches concerning its subject, and provide the recommendation for change that may have a highly positive impact on evidence-based nursing practice.
Practice issue
Despite the relatively well-established treatment plan, diabetes currently remains a severe chronic disease that affects people all over the world. In addition, the gravity of this illness is determined by the number of serious complications. As a matter of fact, diabetes is a widely recognized significant risk factor for multiple clinical outcomes, including various types of cardiovascular events (Cavender, et al., 2015). Regardless of the declining general rates of cardiovascular diseases worldwide, they still may be regarded as the primary cause of morbidity and mortality in patients who suffer from diabetes (Kruger, 2018). In general, diabetes-related cardiovascular complications include stroke, myocardial infarction, cerebrovascular disease, heart failure, peripheral vascular disease, and coronary heart disease (Kruger, 2018). The examination of the prevention of cardiovascular events in patients with diabetes is highly essential for health care providers to provide high-quality efficient treatment.
In the present day, the regular use of low-dose aspirin on a daily basis is regarded as one of the most beneficial practices for the prevention of cardiovascular events, especially in patients with diabetes. In addition, the potential difference between the impact of low-dose aspirin on male and female patients should be considered as women are reportedly more vulnerable to the risk of cardiovascular events, including heart failure, heart attack, atherosclerosis, coronary artery disease, and high blood pressure, in comparison with men (National Institute of Nursing Research, n.d.). In general, the examination of the possibility of aspirin use for the primary and secondary prevention of cardiovascular disease in patients with diabetes on the basis of an appropriately formulated PICOT question provide necessary recommendations for clinicians concerning appropriate treatment and help them to avoid medication errors in their practice.
PICOT question
On the basis of the defined issue, the PICOT question for research will be the following: For women with diabetes (P), does the use of low-dose aspirin on a daily basis (I) reduce the risk of cardiovascular events (O) within several years (T) in comparison with no usage of low-dose aspirin (C)?
The components of the questions include:
- P = Women with diabetes is defined as the target population for the research;
- I = The usage of low-dose aspirin on a daily basis is defined as a basic intervention;
- C = No usage of low-dose aspirin (or placebo treatment) is an alternative to the defined intervention;
- O =The preferable outcome of the intervention is to reduce the risk of cardiovascular events;
- T = The accurate timeframe of the intervention is not defined, however, the defined intervention may take several years for reliable results.
According to the Results of Research
The results of the research dedicated to the expedience of the use of low-dose aspirin for the prevention of cardiovascular disease in patients with diabetes may be regarded as controversial due to two types of prevention. For secondary prevention, the benefits of aspirin as clearly established as, in this case, the efficiency of this medication substantially outweighs potential risks (Patrono & Baigent, 2019). However, the efficiency and safety of aspirin for primary prevention remained unclear as this medication has no substantial effect on the reduction of major cardiovascular events (Capodanno & Angiolillo, 2016). At the same time, the use of low-dose aspirin for prevention in male and female patients with diabetes mellitus and without cardiovascular disease in past medical history increases the risk of intracranial hemorrhage, intracranial bleeding, intracerebral hemorrhage, subdural or extradural hemorrhage, and subarachnoid hemorrhage (Huang, et al., 2019).
Although the efficiency of low-dose aspirin, especially for the secondary prevention of cardiovascular diseases, is evidently proved both for female and male patients, it is reportedly more beneficial for the reduction of stroke in women and cardiovascular accidents in men (Capodanno & Angiolillo, 2016). In general, low-dose aspirin for the primary prevention of cardiovascular diseases in patients with diabetes may be regarded as the medication of choice, and it could not be used on a routine basis (Santilli, et al., 2015)
Recommendation
According to the critical review of multiple researches dedicated to the impact of aspirin on patients with diabetes for the prevention of cardiovascular events, it is possible to conclude that this medication is not effective for primary prevention. That is why, changes should be initiated in order to keep the efficiency of nursing practice, and the evidence-based recommendation for such changes implies the use of another therapy for primary prevention. For patients with diabetes and without cardiovascular events in past medical history, glucose control and reduction may be regarded as a beneficial practice. While the risk of cardiovascular disease with underlying diabetes constantly exists, for individuals with impaired fasting glucose, this risk becomes more significant (Stewart, et al., 2017). At the same time, serum glucose reduction in diabetes mellitus leads to the prevention of cardiovascular events (Stewart, et al., 2017).
Traditionally, health care providers and patients are included in the processes of glucose control and reduction. While the substantial glucose reduction is performed under the control of clinicians, self-monitoring of blood glucose included in diabetes therapy is defined as an effective method of complementary individual glucose level observing. In addition, it is highly essential for insulin-dependent patients in order to avoid morbidities, including cardiovascular disease. All patients who monitor their glucose level individually should receive instructions from health care professionals concerning the accuracy of techniques and results.
In general, glucose control and reduction is an appropriate and accessible technique for the prevention of cardiovascular events “pertinent in the diabetic populations” and non-significantly associated with the risk in non-diabetics (Stewart, et al., 2017, p. 6). According to recent trials, the sodium/glucose transporter 2 inhibitor class of oral hypoglycaemics such as empagliflozin significantly reduces the cardiovascular disease death rate by 28% and all-cause mortality by 32% (Stewart, et al., 2017). The substantial benefits of glucose reduction therapy make it highly recommendable for early use in both male and female patients with diabetes.
Conclusion
In general, diabetes is a severe chronic disease that affects people all over the world and causes a substantial number of serious complications, including various types of cardiovascular events. According to the results of the multiple studies’ critical review dedicated to the use of low-dose aspirin for the prevention of cardiovascular disease, this medication is beneficial for secondary prevention. At the same time, for primary prevention, the efficiency of aspirin remains unclear as it has no substantial effect on the reduction of cardiovascular events and increases bleeding. In turn, glucose control and reduction may be regarded as an appropriate alternative strategy for primary prevention in patients with diabetes.
References
Capodanno, D., & Angiolillo, D. J. (2016). Aspirin for primary cardiovascular risk prevention and beyond in diabetes mellitus. Circulation, 134(20), 1579-1594.
Cavender, M. A., Steg, G., Smith Jr., S. C., Eagle, K., Ohman, E. M., Goto, S., Kuder, J., Im, K., Wilson, P. W. F., & Bhatt, D. L. (2015). Impact of diabetes mellitus on hospitalization for heart failure, cardiovascular events, and death. Circulation, 132(10), 1-9.
Huang, W., Saver, J. L., Wu, Y., Lin, C., Lee, M., & Ovbiagele, B. (2019). Frequency of intracranial hemorrhage with low-dose aspirin in individuals without symptomatic cardiovascular disease: A systematic review and meta-analysis. JAMA Neurology, 76(8), 906-914.
Kruger, D. (2018). Cardiovascular outcome trials in type 2 diabetes: A nurse practitioner perspective. Journal of the American Association of Nurse Practitioners, 30, 43-52.
National Institute of Nursing Research. (n.d.). Subtle and dangerous: Symptoms of heart disease in women [PDF document]. Web.
Patrono, C., & Baigent, C. (2019). Role of aspirin in primary prevention of cardiovascular disease. Nature Reviews Cardiology,16, 675–686.
Santilli, F., Pignatelli, P., Violi, F., & Davi, G. (2015). Aspirin for primary prevention in diabetes mellitus: from the calculation of cardiovascular risk and risk/benefit profile to personalised treatment. Thrombosis and Haemostasis, 114(5), 876-882.
Stewart, J., Manmathan, G., & Wilkinson, P. (2017). Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. Journal of the Royal Society of Medicine Cardiovascular Disease, 6, 1-9.