Which diabetic patients should be taking aspirin?BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.7006.641 (Published 09 September 1995) Cite this as: BMJ 1995;311:641
- John S Yudkin
- Professor of medicine University College London Medical School, Whittington Hospital, London N19 3UA
Those with vascular disease and those at greatly increased risk of vascular disease
Low dose aspirin has been shown to reduce the risk of myocardial infarction and thrombotic stroke in patients at high risk of vascular death. Does aspirin work in diabetic patients? Is the diagnosis of diabetes sufficient to warrant starting a patient on aspirin? And does aspirin confer any specific advantages or risks on these patients?
Firstly, does it help? Several large studies have been conducted in diabetic patients, some aimed at preventing cardiovascular disease and others at slowing progression of retinopathy or nephropathy. The Veterans Administration study looked at the efficacy of aspirin and dipyridamole in preventing progression of cardiovascular and peripheral vascular disease in 231 diabetic men with limb gangrene or recent amputation for ischaemia.1 There were no differences in the incidence of either end point. The early treatment diabetic retinopathy study randomised 3711 patients with insulin dependent and non-insulin dependent diabetes to aspirin 650 mg daily or placebo.2 Patients treated with aspirin had 13% fewer cardiovascular deaths—a non-significant difference.
Inevitably, small numbers of patients and events in studies of this type result in outcomes with fairly wide confidence intervals. The Antiplatelet Trialists' Collaboration avoided the problem of small numbers by conducting a meta-analysis of the efficacy of antiplatelet agents in preventing myocardial infarction, stroke, and vascular death.3 Among nearly 47000 patients considered to be at …