Acetylsalicylic Acid (Aspirin) for Primary Prevention of Cardiovascular Events in Patients with Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

IF 2.8 3区医学 Q2 PERIPHERAL VASCULAR DISEASE Current vascular pharmacology Pub Date : 2023-01-01 DOI:10.2174/1570161121666230131120544

Shuangbo Liu, Janine Eckstein, Anna Lam, Asim N Cheema

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引用次数: 1

Abstract

Background: Evidence regarding using acetylsalicylic acid (aspirin) for the prevention of cardiovascular (CV) events in patients with diabetes mellitus (DM) is inconsistent. Therefore, we performed a meta-analysis.

Methods: A literature search was performed (January 1990 to February 2022) and publications meeting the inclusion criteria were reviewed, and a meta-analysis was performed using RevMan software. The primary outcome was a composite of CV death, non-fatal myocardial infarction (MI) and stroke. Secondary outcomes included all-cause mortality, individual components of the primary outcome and major bleeding.

Results: The study cohort comprised 33525 diabetic patients from 9 randomized controlled trials. The primary outcome was significantly lower for aspirin vs. placebo (7.9 vs. 8.6, RR (risk ratio) 0.92, 95% CI (confidence interval) 0.86-0.99). All-cause mortality (10 vs. 10.3%, RR 0.97, 95% CI 0.90-1.03), CV death (4.4 vs. 4.7%, RR 0.93, 95% CI 0.83-1.04), non-fatal MI (4.6 vs. 4.8% RR 0.97, 95% CI 0.83- 1.15) and stroke (3.2 vs. 3.5%, RR 0.89, 95% CI 0.75-1.06) were similar between the two treatment groups. Major bleeding was significantly higher for aspirin compared with placebo (3.4 vs. 2.8%, RR 1.18, 95% CI 1.01-1.39).

Conclusion: Aspirin use in patients with DM reduces the composite endpoint of CV death, non-fatal MI and stroke compared with a placebo. However, routine use of aspirin for primary prevention among diabetic patients cannot be advised due to the increased risk of major bleeding. These findings suggest careful risk assessment of individual patients.

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乙酰水杨酸(阿司匹林)对糖尿病患者心血管事件的一级预防:随机对照试验的系统回顾和荟萃分析

背景:关于使用乙酰水杨酸(阿司匹林)预防糖尿病(DM)患者心血管(CV)事件的证据不一致。因此，我们进行了荟萃分析。方法:进行文献检索(1990年1月至2022年2月)，回顾符合纳入标准的出版物，并使用RevMan软件进行meta分析。主要终点是CV死亡、非致死性心肌梗死(MI)和卒中的综合结果。次要结局包括全因死亡率、主要结局的个别组成部分和大出血。结果:该研究队列包括来自9项随机对照试验的33525名糖尿病患者。阿司匹林组的主要结局明显低于安慰剂组(7.9 vs 8.6, RR(风险比)0.92,95% CI(可信区间)0.86-0.99)。两个治疗组的全因死亡率(10比10.3%，RR 0.97, 95% CI 0.90-1.03)、CV死亡(4.4比4.7%，RR 0.93, 95% CI 0.83-1.04)、非致死性心肌梗死(4.6比4.8% RR 0.97, 95% CI 0.83- 1.15)和卒中(3.2比3.5%，RR 0.89, 95% CI 0.75-1.06)相似。阿司匹林组大出血发生率明显高于安慰剂组(3.4 vs 2.8%， RR 1.18, 95% CI 1.01-1.39)。结论:与安慰剂相比，阿司匹林可降低糖尿病患者心血管死亡、非致死性心肌梗死和卒中的复合终点。然而，不能建议糖尿病患者常规使用阿司匹林进行一级预防，因为这会增加大出血的风险。这些发现建议对个别患者进行仔细的风险评估。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Current vascular pharmacology 医学-外周血管病

CiteScore

9.20

自引率

4.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Current Vascular Pharmacology publishes clinical and research-based reviews/mini-reviews, original research articles, letters, debates, drug clinical trial studies and guest edited issues to update all those concerned with the treatment of vascular disease, bridging the gap between clinical practice and ongoing research. Vascular disease is the commonest cause of death in Westernized countries and its incidence is on the increase in developing countries. It follows that considerable research is directed at establishing effective treatment for acute vascular events. Long-term treatment has also received considerable attention (e.g. for symptomatic relief). Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. The latter include cardiology, vascular and cardio thoracic surgery, general medicine, radiology, clinical pharmacology and neurology (stroke units).