Aspirin is recommended by key guideline agencies for the primary prevention of cardiovascular events in people with diabetes (Diabet Med 2006; 23:579-93; Circulation 2007; 115:114-26; Eur Heart J 2007; 28:88-136; Endocr Pract 2007; 13 (supp 1):1-68; CMAJ 2008; 179:920-6; Eur Heart J 2007; 28:1925-7). Evidence supporting the efficacy of aspirin therapy in trials of only people with diabetes is scant. The aim of this study is to evaluate the benefits and harms of low dose aspirin in people with diabetes and no cardiovascular disease. The authors have included prospective, randomized, controlled, open or blinded trials of participants with diabetes mellitus who were allocated to aspirin treatment or a control group for the primary prevention of cardiovascular disease. The outcomes have been all cause mortality, death from cardiovascular causes, non fatal myocardial infarction and non fatal stroke. The results are these: 1) when the aspirin has been compared with placebo there has not been statistically significant reduction in the risk of major cardiovascular events, cardiovascular mortality, all cause mortality; 2) aspirin significantly has reduced the risk of myocardial infarction in men but no in women; 3) evidence relating to harms has been inconsistent; 4) a clear benefit of aspirin in the primary prevention of major cardiovascular events in people with diabetes remains unproved; 5) sex may be an important effect modifier; 6) toxicity is to be explored further.
Posted January 25th 2010