Diabetes primary prevention of cardiovascular events: Difference between revisions
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==Overview== | ==Overview== | ||
Diabetics are 2-4 times more likely to sustain a cardiovascular event when compared to age and sex matched controls <ref>Centers for Disease Control and Prevention National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007Atlanta, Ga: U.S: Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.</ref> Given the high risk of diabetic patients for cardiovascular events, there is tremendous ongoing interest in identifying therapies that might prevent a first event. In 2004, the U.S. Preventive Services Task Force recommended low dose aspirin as a primary preventive strategy in men aged 45 to 79 years and in women age 55 to 79 years, ''irrespectiv''e of the presence of diabetes. The safety and efficacy of low-dose aspirin in the primary prevention of cardiovascular events in patients with type 2 diabetes remains controversial. | |||
==Primary Prevention with Aspirin== | |||
In one prospective, [[randomized]], multicenter, blinded trial, 2,539 type 2 diabetes patients with no history of atherosclerotic events were followed for a median of 4.4 years were randomized to either low-dose [[aspirin]] (81 or 100 mg per day) or placebo control<ref name="pmid18997198">{{cite journal| author=Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N et al.| title=Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. | journal=JAMA | year= 2008 | volume= 300 | issue= 18 | pages= 2134-41 | pmid=18997198 | doi=10.1001/jama.2008.623 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18997198 }} </ref>. There was no difference in the risk of fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke, and peripheral arterial disease: | |||
13.6 events per 1000 person-years in the aspirin group vs 17.0 per 1000 person-years in the non-aspirin group, hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.58-1.10; log-rank test, P = .16). For the secondary endpoint of fatal coronary events and fatal cerebrovascular events, there was a significant advantage of low dose aspirin: there was 1 stroke among the patients treated with aspirin and there were 5 fatal myocardial infarctions and 5 fatal strokes in the nonaspirin group (HR, 0.10; 95% CI, 0.01-0.79; P = .0037). With respect to all cause mortality, 34 aspirin patients and 38 non-aspirin patients died from any cause (HR, 0.90; 95% CI, 0.57-1.14; log-rank test, P = .67). Thus, although the results were somewhat mixed, the primary endpoint did not favor aspirin, among patients with [[type 2 diabetes]], and the use of low-dose aspirin was not judged to be effective in [[primary prevention]] of [[atherosclerotic]] events. | |||
==References== | ==References== | ||
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Latest revision as of 20:44, 22 November 2011
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diabetics are 2-4 times more likely to sustain a cardiovascular event when compared to age and sex matched controls [1] Given the high risk of diabetic patients for cardiovascular events, there is tremendous ongoing interest in identifying therapies that might prevent a first event. In 2004, the U.S. Preventive Services Task Force recommended low dose aspirin as a primary preventive strategy in men aged 45 to 79 years and in women age 55 to 79 years, irrespective of the presence of diabetes. The safety and efficacy of low-dose aspirin in the primary prevention of cardiovascular events in patients with type 2 diabetes remains controversial.
Primary Prevention with Aspirin
In one prospective, randomized, multicenter, blinded trial, 2,539 type 2 diabetes patients with no history of atherosclerotic events were followed for a median of 4.4 years were randomized to either low-dose aspirin (81 or 100 mg per day) or placebo control[2]. There was no difference in the risk of fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke, and peripheral arterial disease: 13.6 events per 1000 person-years in the aspirin group vs 17.0 per 1000 person-years in the non-aspirin group, hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.58-1.10; log-rank test, P = .16). For the secondary endpoint of fatal coronary events and fatal cerebrovascular events, there was a significant advantage of low dose aspirin: there was 1 stroke among the patients treated with aspirin and there were 5 fatal myocardial infarctions and 5 fatal strokes in the nonaspirin group (HR, 0.10; 95% CI, 0.01-0.79; P = .0037). With respect to all cause mortality, 34 aspirin patients and 38 non-aspirin patients died from any cause (HR, 0.90; 95% CI, 0.57-1.14; log-rank test, P = .67). Thus, although the results were somewhat mixed, the primary endpoint did not favor aspirin, among patients with type 2 diabetes, and the use of low-dose aspirin was not judged to be effective in primary prevention of atherosclerotic events.
References
- ↑ Centers for Disease Control and Prevention National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2007Atlanta, Ga: U.S: Department of Health and Human Services, Centers for Disease Control and Prevention; 2008.
- ↑ Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N; et al. (2008). "Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial". JAMA. 300 (18): 2134–41. doi:10.1001/jama.2008.623. PMID 18997198.