Aspirin offers benefit for primary CVD prevention in DM

  • Seidu S & al.
  • Cardiovasc Diabetol
  • 3 Jun 2019

  • International Clinical Digest
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Takeaway

  • Low-dose aspirin is potentially beneficial in primary cardiovascular disease (CVD) prevention in diabetes mellitus (DM).
  • Use may need to be individualized based on baseline CVD and bleeding risks.

Why this matters

  • CVD is the leading cause of death in diabetes.
  • Recommendations differ, and some data suggest that bleeding risk outweighs benefit.

Study design

  • Meta-analysis, 12 randomized controlled trials comparing aspirin with placebo or no treatment, including 34,227 participants with diabetes.  
  • Funding: NIHR CLAHRC-EM.

Key results

  • Major adverse cardiac events (MACEs) were significantly reduced with aspirin therapy (relative risk, 0.89; 95% CI, 0.83-0.95): 
    • Absolute risk reduction (ARR), 1.06% (0.48%-1.63%); and
    • Number needed to treat (NNT) to prevent 1 MACE, 95 (61-208).
  • Aspirin was not associated with significant decreases (ARRs; 95% CIs) in:
    • All-cause mortality: 0.95 (0.88-1.02),
    • Myocardial infarction: 0.84 (0.64-1.11),
    • Coronary heart disease: 0.98 (0.79-1.21),
    • Stroke: 0.88 (0.72-1.08), or
    • CVD death: 0.92 (0.78-1.08).
  • Aspirin use reduced MACE risk in nonsmokers (0.70; 0.51-0.96) vs smokers (1.77; 0.91-3.45), with NNT to prevent 1 MACE, 33 (20-246).
  • In pooled data, no significant differences in major bleeding (1.30; 0.92-1.82), gastrointestinal bleeding (1.48; 0.87-2.49), or nongastrointestinal bleeding (2.91; 0.20-41.94), nor in other investigated adverse events.  

Limitations

  • Variation across studies in reporting of outcome definitions and other data.