Aspirin for primary prevention of cardiovascular events in patients with diabetes: A meta-analysis

Zhang, Chunyu; Sun, Aijun; Zhang, Peng; Wu, Chunlei; Zhang, Shuning; Fu, Mingqiang; Wang, Keqiang; Zou, Yunzeng; Ge, Junbo

doi:10.1016/j.diabres.2009.09.029

Cited by 132 publications

(112 citation statements)

References 32 publications

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“…Our results are consistent with observations from previous meta-analyses assessing aspirin use for primary prevention of cardiovascular events in people with diabetes 16,17,[19][20][21] and other high-risk patient populations. 18 These metaanalyses used various combinations of data from nine randomized controlled trials to examine the effect of 50-650 mg daily aspirin on primary prevention of cardiovascular events.…”

Section: Previous Literaturesupporting

confidence: 83%

“…17,19 Of particular relevance to our meta-analysis, we found only one study that randomly allocated patients to different aspirin doses. 43 To maximize inclusion of potentially relevant articles, our pre-specified search strategy used six well-recognized, comprehensive electronic databases and database-appropriate terms designed to capture a wide range of comparative studies evaluating aspirin use in diabetes.…”

Section: Limitationsmentioning

confidence: 99%

“…[16][17][18][19][20][21] One possible explanation for the apparent lack of benefit is aspirin resistance. 22 Diabetes is associated with numerous biochemical abnormalities, including elevated platelet reactivity.…”

Section: -3mentioning

confidence: 99%

“…[6][7][8][9]11,12,38,44,52,54 Despite differences in study inclusion, all six meta-analyses reported similar pooled risk ratios for cardiovascular outcomes (Table 4). [16][17][18][19] We excluded the ETDRS and Hypertension Optimal Treatment (HOT) studies from our stratified analyses examining aspirin use in primary ; Article=data obtained from original article; ADA Statement=data obtained from the American Diabetes Association position statement on aspirin use for primary prevention in diabetes 16 ) †Number of diabetic patients and proportion of entire study sample ‡Presence of cardiovascular disease at baseline for entire study sample §All patients had peripheral arterial disease at baseline ║All patients had unstable angina MI=Myocardial Infarction; TIA=Transient Ischemic Attack; CHD=Coronary Heart Disease; NR=Not Reported prevention because 8% and 11% of patients reported a history of cardiovascular disease at enrolment, respectively. 7,9 Therefore, we could not be certain if these studies were reporting primary or secondary cardiovascular events.…”

Section: Previous Literaturementioning

confidence: 99%

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Effect of Aspirin Dose on Mortality and Cardiovascular Events in People with Diabetes: A Meta-Analysis

et al. 2011

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OBJECTIVES: Pharmacologic evidence suggests adequate antiplatelet activity in diabetic patients requires >100 mg aspirin daily, yet recent trials have used ≤100 mg daily. This meta-analysis explored the relationship between aspirin dose and prevention of cardiovascular events. DATA SOURCES: Six electronic databases were searched using database-appropriate terms for aspirin, diabetes, and comparative study from inception until February 2010. REVIEW METHODS: Randomized controlled trials and cohort studies comparing aspirin to no antiplatelet therapy were included if they reported cardiovascular events as pre-specified outcomes, aspirin dose, and number of diabetic patients. Studies were stratified by daily aspirin dose (≤100 mg; 101-325 mg; >325 mg) and pooled risk ratios (RR) were calculated using random effects models. All-cause mortality was the primary outcome of interest. Cardiovascular-related mortality, myocardial infarction, and stroke were secondary outcomes. RESULTS: Data for diabetic patients were available from 21 studies (n=17,522). Overall, 1,172 (15.4%) of 7,592 aspirin users and 1,520 (18.4%) of 8,269 controls died (p=0.31). The pooled RRs were 0.89 (95% CI: 0.72-1.10; p=0.27) from 13 studies using ≤100 mg (I 2 =64%); 0.89 (95% CI: 0.61-1.30; p=0.55) from four studies using 101-325 mg (I 2 =83%); and 0.96 (95% CI: 0.85-1.08; p= 0.50) from eight studies using >325 mg (I 2 =0%). Aspirin use was associated with a significantly lower risk of mortality (RR: 0.82; 95% CI: 0.69-0.98; p=0.03) in 13 secondary prevention studies (I 2 =27%), whereas aspirin use in seven primary prevention studies (I 2 =0%) was not (RR: 1.01; 95% CI 0.85-1.19; p=0.94). A substantial amount of heterogeneity was observed amongst studies in all outcomes. Although inclusion of cohort studies was a major source of heterogeneity, stratification by study design did not reveal a significant dose-response relationship. CONCLUSIONS/INTERPRETATION: This summary of available data does not support an aspirin dose-response effect for prevention of cardiovascular events in diabetic patients. However, the systematic review identified an important gap in randomized controlled trial evidence for using 101-325 mg aspirin daily in diabetes.

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Section: Previous Literaturesupporting

confidence: 83%

Section: Limitationsmentioning

confidence: 99%

Section: -3mentioning

confidence: 99%

Section: Previous Literaturementioning

confidence: 99%

See 2 more Smart Citations

Effect of Aspirin Dose on Mortality and Cardiovascular Events in People with Diabetes: A Meta-Analysis

et al. 2011

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“…There is sufficient clinical evidence that in patients with T2DM who have had cardiovascular diseases, lowering blood pressure, lowering lipids, or the proper use of aspirin therapy alone or in combination can reduce the risk of cardiovascular disease recurrence and death 35, 39, 40, 41, 42, 43. In patients with diabetic nephropathy, the use of blood pressure‐lowering agents, particularly the use of angiotensin‐converting enzyme inhibitor or angiotensin II receptor antagonist drugs, significantly reduced the risk of diabetic nephropathy progression 43.…”

Section: Primary Secondary and Tertiary Diabetes Preventionmentioning

confidence: 99%