Aspirin for primary prevention of cardiovascular and all‐cause mortality events in diabetes: updated meta‐analysis of randomized controlled trials
Abstract Aims To evaluate the benefits and harms of aspirin for the primary prevention of cardiovascular disease and all‐cause mortality events in people with diabetes by conducting a systematic review and meta‐analysis. Methods Randomized controlled trials of aspirin compared with placebo (or no treatment) in people with diabetes with no history of cardiovascular disease were identified from MEDLINE, EMBASE, Web of Science, the Cochrane Library and a manual search of bibliographies to November 2015. Study‐specific relative risks with 95% CIs were aggregated using random effects models. Results A total of 10 randomized trials were included in the review. There was a significant reduction in risk of major adverse cardiovascular events: relative risk of 0.90 (95% CI 0.81–0.99) in groups taking aspirin compared with placebo or no treatment. Limited subgroup analyses suggested that the effect of aspirin on major adverse cardiovascular events differed by baseline cardiovascular disease risk, medication compliance and sex ( P for interaction for all > 0.05).There was no significant reduction in the risk of myocardial infarction, coronary heart disease, stroke, cardiovascular mortality or all‐cause mortality. Aspirin significantly reduced the risk of myocardial infarction for a treatment duration of ≤ 5 years. There were differences in the effect of aspirin by dosage and treatment duration on overall stroke outcomes ( P for interaction for all Conclusions The emerging data do not clearly support guidelines that encourage the use of aspirin for the primary prevention of cardiovascular disease in adults with diabetes who are at increased cardiovascular disease risk.
What's new? This updated meta‐analysis only suggests a modest benefit of aspirin in the prevention of major adverse cardiovascular event/s (MACE) in people with diabetes.Limited subgroup analyses suggest there are differences in the effect of aspirin on MACE according to baseline cardiovascular disease (CVD) risk, medication compliance and sex.The overall evidence does not clearly support guidelines that encourage the use of aspirin for the primary prevention of CVD in adults with diabetes who are at increased CVD risk.
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