Aspirin effect on the incidence of major adverse cardiovascular events in patients with diabetes mellitus: a systematic review and meta-analysis

Cardiovascular Diabetology

Review

Alexander A Leung¹  Sonia Butalia¹  William A Ghali²  Doreen M Rabi³ 

[1] Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada;Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada;Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada;Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada;Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada;Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada;

关键词: Aspirin;    Relative Risk;    Major Adverse Cardiovascular Event;    Aspirin Therapy;    Early Treatment Diabetic Retinopathy Study;   

DOI  :  10.1186/1475-2840-10-25

 received in 2011-03-08, accepted in 2011-04-01,  发布年份 2011

来源: Springer

【 摘 要 】

BackgroundAspirin has been recommended for the prevention of major adverse cardiovascular events (MACE, composite of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death) in diabetic patients without previous cardiovascular disease. However, recent meta-analyses have prompted re-evaluation of this practice. The study objective was to evaluate the relative and absolute benefits and harms of aspirin for the prevention of incident MACE in patients with diabetes.MethodsWe performed a systematic review and meta-analysis on seven studies (N = 11,618) reporting on the use of aspirin for the primary prevention of MACE in patients with diabetes. Two reviewers conducted a systematic search of electronic databases (MEDLINE, EMBASE, the Cochrane Library, and BIOSIS) and hand searched bibliographies and clinical trial registries. Reviewers extracted data in duplicate, evaluated the quality of the trials, and calculated pooled estimates.ResultsA total of 11,618 participants were included in the analysis. The overall risk ratio (RR) for MACE was 0.91 (95% confidence intervals, CI, 0.82-1.00) with little heterogeneity among trials (I2 0.0%). Secondary outcomes of interest included myocardial infarction (RR, 0.85; 95% CI, 0.66-1.10), stroke (RR, 0.84; 95% CI, 0.64-1.11), cardiovascular death (RR, 0.95; 95% CI, 0.71-1.27), and all-cause mortality (RR, 0.95; 95% CI, 0.85-1.06). There were higher rates of hemorrhagic and gastrointestinal events. In absolute terms, these relative risks indicate that for every 10,000 diabetic patients treated with aspirin, 109 MACE may be prevented at the expense of 19 major bleeding events (with the caveat that the relative risk for the latter is not statistically significant).ConclusionsThe studies reviewed suggest that aspirin reduces the risk of MACE in patients with diabetes without cardiovascular disease, while also causing a trend toward higher rates of bleeding and gastrointestinal complications. These findings and our absolute benefit and risk calculations suggest that those with diabetes but without cardiovascular disease lie somewhere between primary and secondary prevention patients on the spectrum of benefit and risk. This underscores the importance of considering individual risk in clinical decision making regarding aspirin in those with diabetes.

【 授权许可】

CC BY   
© Butalia et al; licensee BioMed Central Ltd. 2011