Aspirin in type 2 diabetes: is there any evidence base?
BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a1902 (Published 16 October 2008) Cite this as: BMJ 2008;337:a1902
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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
Competing interests: No competing interests
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
Competing interests: No competing interests