Diabetes Research Review in 2018 has published the following two reviews which you will find of interest; Effects of aspirin for primary prevention in persons with diabetes mellitus & the effect of aspirin on cardiovascular events and bleeding in the healthy elderly. Its interesting to note the comment ”This is strong evidence that aspirin has no place in routine primary prevention in the elderly.”
Effects of aspirin for primary prevention in persons with diabetes mellitus
Authors: The ASCEND Study Collaborative Group
”Adults with diabetes but no evident CV disease (n=15,480) were randomised to receive aspirin 100 mg/day or placebo, and were followed for a mean of 7.4 years.
Compared with placebo, aspirin recipients had a significantly lower rate of serious vascular events (primary outcome [myocardial infarction, stroke/transient ischaemic attack or death from any vascular cause, excluding confirmed intracranial haemorrhage]; 8.5% vs. 9.6%; rate ratio 0.88 [95% CI 0.79–0.97]), but a significantly higher rate of major bleeding events (4.1% vs. 3.2%; 1.29 [1.09–1.52]), mostly GI and other extracranial bleeding.
There was no significant between-group difference for the incidences of GI tract cancer or any cancer, although longer term follow-up is planned for these outcomes.
While there is no doubt about the benefits of low-dose aspirin therapy in patients with known CV disease, there has been no clear answer regarding aspirin use in the primary prevention space in patients with diabetes.
This large RCT showed a 12% reduction in CV outcomes in patients with type 2 diabetes without known CV disease.
This was however associated with a 29% increase in major bleeding events. There was no effect of aspirin on CV death or cancer rates.
This is the most definitive evidence so far that aspirin use in patients with type 2 diabetes for primary prevention is associated with significant risks that outweigh the small benefits.
Reference: N Engl J Med; Published online Aug 26, 2018″ Click here for Abstract>>
Effect of aspirin on cardiovascular events and bleeding in the healthy elderly
Authors: McNeil JJ et al., for the ASPREE Investigator Group
“Elderly individuals from the community with no CV disease, dementia or disability were randomised to receive enteric-coated aspirin 100mg (n=9525) or placebo (n=9589) in this research with median follow-up of 4.7 years.
There was no significant difference between the aspirin and placebo recipients for CV disease (10.7 vs. 11.3 events per 1000 person-years), and the major haemorrhage rate was higher among aspirin recipients (8.6 vs. 6.2 events per 1000 person-years; HR 1.38 [95% CI 1.18–1.62]).
To continue with the low-dose aspirin theme, three papers have emerged as result of the ASPREE (Aspirin in Reducing Events in the Elderly) trial, in which nearly 20,000 elderly participants without CV disease were enrolled in a low-dose aspirin primary prevention study.
In this paper, the primary CV endpoint is presented, which is neutral (HR 0.95) and was associated with a 38% increase risk of major haemorrhage. Notably, high-risk groups including diabetes, smoking and obesity had no signal of CV benefit. This is strong evidence that aspirin has no place in routine primary prevention in the elderly. ”
Reference: N Engl J Med; Published online Sept 16, 2018 Click here for Abstract>>
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