Aspirin for the primary prevention of cardiovascular events: A systematic review and meta-analysis comparing patients with and without diabetes

Andrew D. Calvin, Niti R. Aggarwal, Mohammad Hassan Murad, Qian Shi, Mohamed B. Elamin, Jeffrey B. Geske, M. Merce Fernandez-Balsells, Felipe N. Albuquerque, Julianna F. Lampropulos, Patricia J. Erwin, Steven A. Smith, Victor M. Montori

Research output: Contribution to journalArticlepeer-review

83 Scopus citations

Abstract

OBJECTIVE- The negative results of two randomized controlled trials (RCTs) have challenged current guideline recommendations for using aspirin for primary prevention of cardiovascular events among patients with diabetes. We therefore sought to determine if the effect of aspirin for primary prevention of cardiovascular events and mortality differs between patients with and without diabetes. RESEARCH DESIGN AND METHODS- We conducted a systematic search of MEDLINE, EMBASE, Cochrane Library, Web of Science, and Scopus since their inceptions until. November 2008 for RCTs of aspirin for primary prevention of cardiovascular events. Blinded pairs of reviewers evaluated studies and extracted data. Random-effects meta-analysis and Bayesian logistic regression were used to estimate the ratios of relative risks (RRs) of outcomes of interest among patients with and without diabetes. A 95% CI that crosses 1.00 indicates that the effect of aspirin does not differ between patients with and without diabetes. RESULTS- Nine RCTs with moderate to high methodological quality contributed data to the analyses. The ratios of RRs comparing the benefit of aspirin among patients with diabetes compared with patients without diabetes for mortality, myocardial infarction, and ischemic stroke were 1.12 (95% CI 0.92-1.35), 1.19 (0.82-1.17), and 0.70 (0.25-1.97), respectively. CONCLUSIONS- Whereas estimates of benefit among patients with diabetes remain imprecise, our analysis suggests that the relative benefit of aspirin is similar in patients with and without diabetes.

Original languageEnglish (US)
Pages (from-to)2300-2306
Number of pages7
JournalDiabetes care
Volume32
Issue number12
DOIs
StatePublished - Dec 2009

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

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