Aspirin Dose for Prevention of Cardiovascular Disease in Diabetics

2003 ◽  
Vol 37 (1) ◽  
pp. 116-121 ◽  
Author(s):  
Sandra N Nowak ◽  
Linda A Jaber
Keyword(s):  
Cardiovascular Disease ◽  
Aspirin Therapy ◽  
Biomedical Literature ◽  
Diabetic Patients ◽  
Vascular Events ◽  
Cardiovascular Protection ◽  
Patients With Diabetes ◽  
Relationship Of ◽  
Key Terms ◽  
Prevention Of Cardiovascular Disease

OBJECTIVE To determine whether a specific dose of aspirin can be recommended for prevention of cardiovascular disease in patients with diabetes. DATA SOURCE Biomedical literature was accessed through MEDLINE (1990–February 2002). Key terms included diabetes, cardiovascular protection, and aspirin. DATA SYNTHESIS Pharmacologic and clinical studies focusing on the dose–response relationship of aspirin therapy were reviewed. Evidence supports the benefit of low-dose aspirin therapy in reducing vascular events in secondary and primary prevention trials in various patient populations; however, some studies suggest larger doses of aspirin may be needed in certain patients. CONCLUSIONS Review of the evidence does not support a particular dose of aspirin for cardiovascular protection in diabetic patients. Clinical guidelines recommend aspirin therapy in the range of 81–325 mg/d. However, due to an increased prevalence of cardiovascular morbidity and disturbances in coagulation in diabetic patients, the dose of aspirin for prevention of cardiovascular disease in these individuals may be different from that in other populations and requires further evaluation.

scholarly journals Prevalence of Aspirin Prescriptions among Type 2 Diabetic Patients in Songklanagarind Hospital

2018 ◽  
Vol 36 (1) ◽  
pp. 35
Author(s):  
Rattanaporn Chootong ◽  
Silom Jamulitrat
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Aspirin Therapy ◽  
P Value ◽  
Diabetic Patients ◽  
Type 2 Diabetic Patients ◽  
History Of ◽  
Prevention Of Cardiovascular Disease

Objective: The American Diabetes Association (ADA) and the American Heart Association (AHA) recommend aspirin use for primary and secondary prevention of cardiovascular disease in patients with diabetes. There are, however, some doubts regarding the prescription of aspirin therapy to prevent cardiovascular events in diabetic patients, aspects of its safety, and contraindications of the drug administration. This study was conducted in order to evaluate the amount of prescribed aspirin for diabetic patients who received the treatment at Songklanagarind Hospital.Material and Method: A cross-sectional study was conducted to review the medical records of diabetic patients who received the treatment at outpatient departments from 1st-31st December 2013.Results: A total of 1,342 diabetic patients are included in this study: 80.3% from the primary prevention group and 19.7% from the secondary prevention group. Mean age was 64.3 years old. Of the patients, 44.7% were male. The study revealed that prescribed aspirin accounted for one-third of total prescriptions (31.7%). The primary prevention group was 19.0% (95% confidence interval (CI)=12.0-21.3) and the secondary prevention group was 83.7% (95% CI=78.6-87.9). The departments that frequently prescribed aspirin for the primary prevention group was endocrinology (21.2%) and for the secondary prevention group it was the Primary Care Unit (87.5%). Aspirin side effects were gastrointestinal 1.0% and tinnitus 0.1%. Aspirin contraindications were active peptic ulcer (0.1%), history of gastrointestinal bleeding (0.4%), bleeding disorders (0.2%), history of recent intracranial bleeding (0.2%) and severe liver disease (0.9%). There was a positive correlation between age, hemoglobin A1c (HbA1c) and the dose of prescribed aspirin (p-value<0.001, 0.003 respectively). These patients were more likely to have the dose of aspirin increased as age and HbA1c increased.Conclusion: Despite aspirin being a safe, inexpensive and readily available therapy that is effective in preventing cardiovascular disease in diabetic patients and likely to provide benefits rather than side effects and contraindications. The author found significant underuse of aspirin therapy, especially in the primary prevention of cardiovascular disease in diabetic patients. 

scholarly journals Role of Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: An updated meta-analysis of randomized controlled trials.

2021 ◽  
Author(s):  
Hua Ma ◽  
QIng Gu ◽  
Huining Niu ◽  
Xiaohua Li ◽  
Rong Wang
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Meta Analysis ◽  
Significant Risk ◽  
Diabetic Patients ◽  
Primary Endpoints ◽  
All Cause Mortality ◽  
Patients With Diabetes ◽  
Rule Out

Background: The use of Aspirin in the primary prevention of cardiovascular disease (CVD) is still a topic of debate, especially in patients with diabetes. The present meta-analysis aims to rule out the efficacy of Aspirin in patients with diabetes and to compare the effectiveness of Aspirin with a placebo (or no treatment) for the primary prevention of CVD and all-cause mortality events in people with diabetes. Materials and Methods: An extensive and systematic search was conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using Aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received Aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The risk of bias (RoB) in included studies was evaluated using the QUADAS-2 tool. Results: A total of 5 studies out of 13 were included with 23,570 diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to the placebo group. In patients with diabetes, there was no difference between Aspirin and placebo with respect to the risk of all-cause death with a confidence interval (CI) varying 0.63 to 1.17. In addition, there were no differences in the bleeding outcomes with an odds ratio of 1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on primary endpoints of cardiovascular events and the bleeding outcomes in diabetic patients compared to placebo. More research on the use of Aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research.

Abstract 6238: Clarifying the Opportunities to Improve Survival After MI in Diabetic Patients

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Lance S Longmore ◽  
Kimberly J Reid ◽  
Mikhail Kosiborod ◽  
Frederick A Masoudi ◽  
Verna Welch ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Patient Characteristics ◽  
Psychosocial Health ◽  
Diabetic Patients ◽  
Biological Factors ◽  
Increased Risk ◽  
Wide Range ◽  
Patients With Diabetes ◽  
Multivariable Models ◽  
Adjusted Model

While diabetes is known to be associated with increased mortality after MI, whether these differences in outcome are due to patient characteristics, treatment, or other biological factors is unknown. We analyzed a contemporary cohort of MI survivors to comprehensively adjust for demographics, comorbidities, psychosocial, health status, clinical and treatment factors to determine if residual disparities in outcomes exist. We studied 2481 hospital survivors of MI in the prospective, 19-center PREMIER study (29% with diabetes). Multivariable models with sequential adjustment were employed to identify the extent to which variation in a wide range of patient characteristics (Figure ) accounted for differences in 3-year mortality in patients with and without diabetes. Unadjusted mortality was more than 2.5-fold greater for patients with diabetes (HR 2.55, 95% CI 2.08–3.14). Mortality was most attenuated by diabetes-related comorbidities (Figure ). The fully-adjusted model identified a significant, albeit attenuated, excess 3-year mortality among patients with diabetes (HR 1.57, 95% CI 1.22–1.99). Patients with diabetes experience a substantially increased risk for 3-year mortality after MI, even after accounting for a wide range of patient and treatment characteristics. This suggests that unmeasured, biologic variables associated with diabetes may mediate this difference. Further inquiry into the pathogenesis of diabetic cardiovascular disease is needed to identify new opportunities to improve the prognosis of patients with diabetes.

scholarly journals Aspirin for primary prevention of cardiovascular outcomes in diabetes mellitus: An updated systematic review and meta-analysis

2019 ◽  
Vol 27 (19) ◽  
pp. 2034-2041 ◽  
Author(s):  
Safi U Khan ◽  
Zain Ul Abideen Asad ◽  
Muhammad U Khan ◽  
Swapna Talluri ◽  
Farman Ali ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Meta Analysis ◽  
Cardiovascular Outcomes ◽  
Randomized Controlled ◽  
Patients With Diabetes ◽  
Incident Cases ◽  
Risk Ratios ◽  
Prevention Of Cardiovascular Disease

Background The safety and efficacy of aspirin for the primary prevention of cardiovascular disease in patients with diabetes mellitus remains controversial. Design A meta-analysis to investigate the effects of aspirin for the prevention of cardiovascular disease in diabetes mellitus. Methods Ten randomized controlled trials were selected using MEDLINE, EMBASE and CENTRAL databases until 27 September 2018. Risk ratios (RRs) with 95% confidence intervals (CIs) and risk differences (RDs) reported as incident events per 1000 person-years were calculated. Results In 33,679 patients, aspirin did not significantly reduce the risk of major adverse cardiovascular outcomes (RR 0.93, 95% CI 0.87–1.00, P = 0.06; RD −0.68 incident cases per 1000 person-years (95% CI −1.54, 0.17)), cardiovascular mortality (RR 0.95, 95% CI 0.83–1.09, P = 0.49; RD 0.11 incident cases per 1000 person-years (95% CI −0.80, 1.02)), myocardial infarction (RR 0.91, 95% CI 0.75–1.11, P = 0.36; RD −0.66 incident cases per 1000 person-years (95% CI −2.07, 0.75)), or stroke (RR 0.91, 95% C, 0.76–1.10, P = 0.33; RD −0.55 incident cases per 1000 person-years (95% CI −1.57, 0.47)). There was a significantly higher risk of total bleeding associated with aspirin (RR 1.29, 95% CI 1.07–1.55, P = 0.01; RD 1.49 incident cases per 1000 person-years (95% CI 0.36, 2.61)). Conclusion The use of aspirin for primary prevention of cardiovascular disease in patients with diabetes mellitus increases the risk of total bleeding without reducing the risk of major adverse cardiovascular outcomes.

scholarly journals Update on RAAS Modulation for the Treatment of Diabetic Cardiovascular Disease

2016 ◽  
Vol 2016 ◽  
pp. 1-17 ◽  
Author(s):  
Stella Bernardi ◽  
Andrea Michelli ◽  
Giulia Zuolo ◽  
Riccardo Candido ◽  
Bruno Fabris
Keyword(s):  
Cardiovascular Disease ◽  
Diabetic Patients ◽  
Paradigm Shifts ◽  
Angiotensin Ii Receptor ◽  
First Line ◽  
Chronic Complications ◽  
First Line Therapy ◽  
Patients With Diabetes ◽  
Receptor Blockers ◽  
Diabetic Population

Since the advent of insulin, the improvements in diabetes detection and the therapies to treat hyperglycemia have reduced the mortality of acute metabolic emergencies, such that today chronic complications are the major cause of morbidity and mortality among diabetic patients. More than half of the mortality that is seen in the diabetic population can be ascribed to cardiovascular disease (CVD), which includes not only myocardial infarction due to premature atherosclerosis but also diabetic cardiomyopathy. The importance of renin-angiotensin-aldosterone system (RAAS) antagonism in the prevention of diabetic CVD has demonstrated the key role that the RAAS plays in diabetic CVD onset and development. Today, ACE inhibitors and angiotensin II receptor blockers represent the first line therapy for primary and secondary CVD prevention in patients with diabetes. Recent research has uncovered new dimensions of the RAAS and, therefore, new potential therapeutic targets against diabetic CVD. Here we describe the timeline of paradigm shifts in RAAS understanding, how diabetes modifies the RAAS, and what new parts of the RAAS pathway could be targeted in order to achieve RAAS modulation against diabetic CVD.

Primum non nocere: An updated meta-analysis on aspirin use in primary prevention of cardiovascular disease in patients with diabetes

2019 ◽  
Vol 26 (15) ◽  
pp. 1677-1679 ◽  
Author(s):  
Federico Fortuni ◽  
Gabriele Crimi ◽  
Valeria Gritti ◽  
Alessandro Mandurino Mirizzi ◽  
Sergio Leonardi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Meta Analysis ◽  
Patients With Diabetes ◽  
Prevention Of Cardiovascular Disease
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