Clinical InvestigationLow-Dose Aspirin for Primary Prevention of Cardiovascular Events in Patients With Diabetes: A Meta-Analysis
Section snippets
Data Sources and Searches
We searched MEDLINE and EMBASE databases for studies evaluating the effect of aspirin in the primary prevention of cardiovascular events in patients with DM through November 2009. Our MEDLINE search included both medical subject headings (MeSH) and keywords including: (1) aspirin OR acetylsalicylic acid AND (2) myocardial infarction OR stroke OR cerebrovascular accident OR cardiovascular diseases OR myocardial ischemia AND (3) primary prevention AND (4) random allocation OR randomized
RESULTS
The results of our search strategy are shown in Figure 1. Seven randomized controlled trials met the inclusion criteria.14., 15., 21., 22., 23., 24., 25. We also extracted data from a published subgroup analysis of the Primary Prevention Project (PPP) trial26 and from a book chapter summarizing subgroup analysis results from the Hypertension Optimal Treatment (HOT) trial.27 We excluded 2 large trials that examined the effect of aspirin in patients with stable angina because > 10% of the
DISCUSSION
Our analysis reveals that, in patients with a history of DM but without apparent cardiovascular disease, the use of low-dose aspirin did not confer protection against the composite endpoint of major cardiovascular events, including cardiovascular death, nonfatal MI and nonfatal stroke. There was also no significant reduction in the individual endpoints of MI, cardiovascular mortality, stroke and all-cause mortality with the use of aspirin. However, we cannot exclude a small beneficial effect of
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Cited by (36)
Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review
2022, SemergenCitation Excerpt :Similarly, the guideline refers specifically to people with DM without ACVD with high CVR and, based on the MA/SR by Khan et al.,48 recommends avoiding the use of ASA in these patients because it increases the risk of MBE without reducing the risk of MACE. Similary, the NICE7 and SIGN3,11 guidelines made their conclusions on the NIHR report,35 a more thorough evaluation which included a report of their own as well as 9 more MA/SR, of which six1,26,28–31 assessed its efficacy and safety in people with DM, concluding with the recommendation against the use of ASA in patients with DM without ACVD. This review contrasts these recommendations, showing several strengths and limitations, compared to previous reviews.
Cardiovascular preventive recommendations. PAPPS 2020 update
2020, Atencion PrimariaLow-dose aspirin for primary prevention of cardiovascular events in patients with diabetes: Benefit or risk?
2018, Diabetes and MetabolismCitation Excerpt :In summary, JPAD2 confirmed that low-dose aspirin had no effect on risk of cardiovascular events in patients with T2D in a primary-prevention setting, but there was an increased risk of gastrointestinal bleeding [80]. Since the ATT meta-analysis was reported, other meta-analyses have addressed primary CVD prevention in diabetes [47,48,52,81–84]: in general, these studies concluded an 8–11% (mostly non-significant) relative reduction in serious vascular events, and no effect on either all-cause or cardiovascular mortality. However, the large CIs do not preclude the potential benefit of aspirin in reducing MI and stroke or the potential harm of increasing major bleeds.
Cardiovascular preventive recommendations. PAPPS Update 2018
2018, Atencion PrimariaAspirin for primary prevention of cardiovascular disease in patients with diabetes: A meta-analysis
2016, Diabetes Research and Clinical PracticeCitation Excerpt :In 2011 the recommendation was revised, and now 75–162 mg of aspirin daily in patients with diabetes is only recommended if 10-year CVD risk score is greater than 10% [7]. Several meta-analyses of patients with diabetes have been performed to evaluate aspirin for prevention of CVD [8–13]. These analyses found no increase in bleeding with aspirin doses ranging from 100 mg every other day to 650 mg per day.