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PRACTICE: Maie Walsh and Geoffrey Spurling Aspirin in type 2 diabetes: is there any evidence base? BMJ 2008; 337: a1902 [Full text]

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there is even more recent evidence of inefficacy of aspirin for primary prevention

oscar,m jolobe   (14 November 2008)

Calculation of cardiovascular risk

Paul Heath   (18 November 2008)

there is even more recent evidence of inefficacy of aspirin for primary prevention 14 November 2008
oscar,m jolobe, retired geriatrician manchester medical society, c/o john rylands university library, oxford road manchester M13 9PP Send response to journal: Re: there is even more recent evidence of inefficacy of aspirin for primary prevention	In the context of prevention of cardiovascular events in type 2 diabetes, Sirois eta al analysed four studies which had to comply with three criteria, namely, an evaluation of prolonged aspirin treatment vs placebo, assessment of cardiovascular morbidity or mortality, or total mortality, and inclusion of subjects with type 2 diabetes. Three of the studies were clinical trials, and they could not prove statistically significant benefit from the use of aspirin. Reduction in cardiac mortality was found only in the observational study(1). More recently, the results were published of a prospective randomized controlled trial of low dose aspirin for primary prevention of atherosclerotic events, including fatal and non-fatal ischaemic heart disease, fatal or non-fatal stroke, and peripheral arterial disease in patients with type 2 diabetes aged 30- 85 without a history of atherosclerosis. One thousand two hundred and sixty two subjects were randomised to aspirin 81-100 mg/day, and 1277 to the non-aspirin group. The median follow-up was 4.37 years, and at the end of the follow-up period 68 atherosclerotic events had occured in the aspirin group, and 86 in the non-aspirin group. A total of 34 patients in the aspirin group and 38 in the non-aspirin group had died from any cause. None of these outcomes were significantly different in the aspirin group vs the non aspirin group. Accordingly, in that study of patients with type 2 diabetes, low-dose aspirin for primary prevention did not reduce the risk of cardiovasvular events. This otcome is consistent with the advice given in the evidence based case report(3), and also consistent with the conclusion that "use of aspirin as a standard treatment at the highest level of evidence in guidelines for subjects with type 2 diabetes should be revisited"(1). References (1) Sirois C., Poirier P., Moisan J., Gregoire J-P The benefit of aspirin therapy in type 2 diabetes: What is the evidence/ International Journal of Cardiology 2008;129:172-9 (2) Ogawa H., Nakayama M., Morimoto T et al Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes. A randomized controlled trial Journal of the American Medical Association 2008:300:2134-41 (3) Walsh M., Spurling G Aspirin in type 2 diabetes: is there any evidence base? British Medical Journal 2008:337:1163-5 Competing interests: None declared
Calculation of cardiovascular risk 18 November 2008
Paul Heath, G.P. Grimsby Send response to journal: Re: Calculation of cardiovascular risk	This article states the cardiovascular risk estimation ,in this patient ,was done using treated blood pressure and lipid levels . In using risk estimation tables in the UK we are told not to use these levels but that the correct figures to use are pretreatment levels. Are the N.Z.tables meant to be used in this way ? Competing interests: None declared