Michael LeFevre, MD, MSPH
In patients with diabetes, is aspirin effective for primary prevention of cardiovascular disease (CVD)?
Included studies compared aspirin with placebo or no treatment in patients with diabetes and no known CVD. Outcomes were major CV events, myocardial infarction (MI), stroke, death from CV causes, all-cause mortality, and adverse effects.
MEDLINE and Cochrane Central Register of Controlled Trials (to Nov 2008); and references were searched for randomized controlled trials (RCTs) with > 500 participants, published in English. 6 RCTs (n = 10 117, mean age 64 to 65 y in 2 RCTs, 0% to 100% men) met the selection criteria. 4 trials were placebo-controlled and double-blind; in all trials, the outcome adjudication committee was blinded. 3 trials reported adequate concealment of allocation. The dose of aspirin ranged from 100 mg every other day to 650 mg/d. Duration of follow-up ranged from 3.6 to 10 years.
Aspirin did not reduce risk for any outcome (Table). In subgroup analyses by sex, aspirin reduced risk for MI in men (relative risk [RR] 0.57, 95% CI 0.34 to 0.94) but not in women (RR 1.1, CI 0.71 to 1.7) (P for interaction 0.056). Risk for stroke was not reduced in either men (RR 1.1, CI 0.75 to 1.6) or women (RR 0.75, CI 0.37 to 1.5) (P for interaction 0.34). Aspirin and control groups did not differ for any bleeding, gastrointestinal bleeding, gastrointestinal symptoms, or cancer.
In patients with diabetes, current evidence shows no overall benefit of aspirin for primary prevention of cardiovascular disease.
Aspirin vs placebo or no treatment (control) for primary prevention of cardiovascular (CV) disease in patients with diabetes*
*Abbreviations defined in Glossary. RRR and CI calculated from data in article using a random-effects model. All results are nonsignificant.
LeFevre M. Review: Current evidence shows no overall benefit of aspirin for primary prevention of cardiovascular disease in diabetes. Ann Intern Med. ;152:JC4–10. doi: 10.7326/0003-4819-152-8-201004200-02010
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Published: Ann Intern Med. 2010;152(8):JC4-10.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Prevention/Screening.
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