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

https://doi.org/10.1016/j.diabres.2009.09.029Get rights and content

Abstract

Background

To systematically review trials concerning the benefit and risk of aspirin therapy for primary prevention of cardiovascular events in patients with diabetes mellitus.

Methods

We searched MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials. Eligible studies were prospective, randomized controlled trials of aspirin therapy for primary cardiovascular prevention in patients with diabetes with follow-up duration at least 12 months.

Results

7 trials included 11,618 individuals with diabetes. Aspirin therapy was not associated with a statistically significant reduction in major cardiovascular events (relative risk [RR] 0.92, 95% confidence interval [CI] 0.83–1.02, p = 0.11). Aspirin use also did not significantly reduce all-cause mortality (0.95, 95% CI 0.85–1.06; p = 0.33), cardiovascular mortality (0.95, 95% CI 0.71–1.27; p = 0.71), stroke (0.83, 95% CI 0.63–1.10; p = 0.20), or myocardial infarction (MI) (0.85, 95% CI 0.65–1.11; p = 0.24). There was no significant increased risk of major bleeding in aspirin group (2.46, 95% CI 0.70–8.61; p = 0.16). Meta-regression suggested that aspirin agent could reduce the risk of stroke in women and MI in men.

Conclusions

In patients with diabetes, aspirin therapy did not significantly reduce the risk of cardiovascular events without an increased risk of major bleeding, and showed sex-specific effects on MI and stroke.

Introduction

The prevalence of diabetes mellitus is rising at an alarming rate and the total number of people with diabetes is projected to more than double by 2030: from 171 million in 2000 to 366 million in 2030 [1]. In people with diabetes, cardiovascular disease is the major cause of morbidity and mortality. It was reported that patients with diabetes had twice the risk of myocardial infarction (MI) and stroke as that of general population, and had a 2–4 fold increased risk of cardiovascular events than those without diabetes [2], [3].

In patients with diabetes, clinical guideline recommended that aspirin therapy as a primary prevention strategy in those patients at increased cardiovascular risk, including those who >40 years of age or who have additional risk factors [2]. However, data from clinical trials and subgroup analyses of larger trials did not show a significant effect of aspirin therapy on cardiovascular events [4], [5]. Thus, to better understand the effect of aspirin therapy on prevention of cardiovascular events in patients with diabetes, we conducted a pooled meta-analysis of randomized controlled trials.

Section snippets

Literature search

The primary aim of this meta-analysis was to determine the effect of aspirin therapy in the prevention of cardiovascular events in patients with diabetes. We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials without language restriction between 1950 and June 2009. The bibliographies of retrieved articles and previous meta-analysis were searched for other relevant studies.

Selection criteria

Trials that met the following criteria were included: (1) prospective randomized controlled

Results

A total of 675 potentially eligible studies were identified and 643 were excluded by reviewing the title and abstract. In the remaining 32 articles, there were five trials included. Another two studies were included by searching the bibliographies of retrieved articles, previous meta-analysis and related reviews. Finally, seven trials involving 11,618 participants were identified for inclusion [4], [5], [9], [10], [11], [12], [13], [14] (Fig. 1). Of seven trials, four for subgroups of

Discussion

The current study, combining data from nearly 12,000 participants, demonstrated that aspirin therapy did not significantly decrease the risk of major cardiovascular events, all-cause mortality, cardiovascular mortality, MI and stroke without an increased risk of major bleeding in patients with diabetes mellitus. Meta-regression and subgroup analysis revealed that aspirin agent could reduce the risk of stroke in diabetic women and MI in diabetic men.

Several studies revealed that aspirin therapy

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgements

This study was funded by National Basic Research Program of China (2006CB503803 & 2005CB523302), 863 Program of Science and Technology Ministry (2006AA0ZA406), Outstanding Youth Grant from National Natural Science Fundation of China (30725036), and Key Projects in the National Science & Technology Pillar Program in the Eleventh Five-year Plan Period (2006BAI01A04).

References (35)

  • J.P.T. Higgins et al.

    Quantifying heterogeneity in a meta-analysis

    Stat. Med.

    (2002)
  • J.P.T. Higgins et al.

    Measuring inconsistency in meta-analyses

    BMJ

    (2003)
  • C.H. Hennekens

    Final report on the aspirin component of the ongoing physicians health study

    N. Engl. J. Med.

    (1989)
  • F.L. Ferris et al.

    Aspirin effects on mortality and morbidity in patients with diabetes mellitus - early treatment diabetic-retinopathy study report-14

    JAMA

    (1992)
  • M. Sacco et al.

    Primary prevention of cardiovascular events with low-dose aspirin and vitamin E in type 2 diabetic patients: results of the primary prevention project (PPP) trial

    Diabetes Care

    (2003)
  • J. Belch et al.

    The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease

    BMJ

    (2008)
  • A. Zanchetti

    Aspirin and antiplatelet drugs in the prevention of cardiovascular complications of diabetes

  • Cited by (0)

    1

    These authors contributed equally to this work.

    View full text