Effects of Omega-3 and Aspirin Use on Cardiovascular Health in Patients with Diabetes

Diabetes is a chronic (long-term) disease that can damage our organs over time, and among causes of death in diabetic patients, cardiovascular diseasesare the leading cause.

Many studies continue to investigate reducing the increased cardiovascular disease risk in diabetic patients. In recent years, globally popular omega-3 fatty acid supplements have been said to be beneficial and recommended in many circumstances. Aspirin is known to protect against vascular blockage and has long been used.

Can we actually reduce the increased risk in diabetic patients using omega-3 supplements and aspirin, claimed to help preserve cardiovascular health?

Recently, NEJM published a study that may answer this question. Oxford University's ASCEND study aimed at evaluating the effects of aspirin and / or omega-3 fatty acids on heart attack and stroke risk in people with diabetes not diagnosed with cardiovascular disease . Let us examine the initial endpoint results from this special study, which began in 2005 and is planned to finish in 2037, reported in 2018.

Study Method - Summary

ASCEND included people over 40 without a history of vascular disease, totaling 15.480 patients with diabetes. In 4 groups, participants received throughout the study 1 gr of omega-3 fatty acid and 100 mg of aspirin, together or separately, or neither in one group (placebo group), with a total follow-up of 7.4 years.

Study Results

• In the Omega-3 supplementation group, heart attacks and strokes occurred at %8.9, while in those not receiving omega-3, given only olive oil (placebo group), the rate was %9.2.
• All-cause mortality was also similar between these groups (%9.7 and %10.2, respectively).
• The aspirin group had fewer serious vascular events such as heart attack and stroke than the placebo group (%8.5 and %9.6, respectively). However, serious bleeding events, such as gastrointestinal bleeding, were more frequent in those taking aspirin than those not taking it (%4.1 and %3.2, respectively).
• There was also no significant difference between aspirin and placebo groups in gastrointestinal cancer incidence (% 2,0 and % 2.0, respectively) or all cancers (% 11.6 and % 11.5). Previous studies had suggested aspirin reduces cancers, particularly bowel cancers, with effects increasing over time.

Ultimately, among patients with diabetes without known cardiovascular disease;

• Taking Omega-3 fatty acid supplements, compared with no supplementation, for preventing cardiovascular disease, provided no protection as was observed.
• Aspirin achieved some success in preventing serious vascular events compared with not taking it. However, it also caused more major bleeding events.
• Again, no significant differences were found in the incidence of gastrointestinal cancers or all other cancers among aspirin users.

Conclusion / Commentary

ASCEND is ongoing, and longer follow-up is needed to see whether any effects emerge later. However, this first phase lasting 7.4 years did not yield results that excited the medical world. Some claim the negative findings arose because daily 1gr omega-3 fatty acid supplementation was insufficient to protect the cardiovascular system. In contrast, many doctors emphasized that they already do not recommend supplements without evidence in routine practice [many organizations, including the American Heart Association (AHA), recommend that for most people, omega-3 at a daily intake of 1 gr is sufficient].

We take this opportunity to remind everyone, with or without diabetes, of the importance for our health of a diet proven to protect cardiovascular health and sustainable throughout life without needing other supplements such as omega-3, a Mediterranean-style diet. 

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