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KMID : 1011320120050030113
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Journal of Pharmacoepidemiology and Risk Management
2012 Volume.5 No. 3 p.113 ~ p.122
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Aspirin on the Primary Prevention of Cardiovascular Diseases in Patients with Diabetes Mellitus
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Kim Mi-Sook
Kim Ye-Jee
Choi Nam-Kyong
Lee Joong-Yub
Park Byung-Joo
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Abstract
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In diabetic patients, cardiovascular disease (CVD) is a leading cause of mortality and morbidity. Moreover, it has a two- to four-fold greater incidence in diabetic patients than in the general population. It has been well established that low-dose aspirin reduces the risk of further myocardial infarction and stroke in patients who already have occlusive vascular disease or associated risk factors. There remains uncertainty, however, as to whether aspirin is beneficial for the primary prevention of CVD. Since 1997, aspirin use had been recommended for diabetic patients without pre-existing CVD, based on the benefit of aspirin in the prevention of cardiovascular events in high risk patients. Meanwhile, subgroup analyses in six preceding trials have produced some contradictory results. More recently, two primary prevention trials in diabetic patients found that aspirin might have no benefit, and that the bleeding risks might outweigh the cardiovascular benefits of aspirin. Meta-analyses have not shown the expected benefits of aspirin in diabetic patients. Furthermore three observational studies showed controversial results. The combined evidence from these investigations has led to conflicting recommendations, and they are not sufficient to clarify whether low-dose aspirin has definite benefits for the primary prevention of CVD. While waiting for data from ongoing large clinical randomized trials and observational studies using a health claims database, this paper reviews the preceded major studies, including clinical trials, and describes the current status of aspirin therapy in the prevention of cardiovascular diseases in diabetic patients.
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KEYWORD
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Aspirin, Diabetes mellitus, Cardiovascular disease, Primary prevention
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