Aspirin for the primary prevention of cardiovascular disease in type 2 diabetes
Keywords:
aspirin, type 2 diabetes mellitus, cardiovascular diseaseAbstract
Cardiovascular disease (CVD) is the most prevalent cause of mortality and morbidity in patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and insulin resistance play a critical role in the development of atherosclerosis, and the coexistence of hypertension (HT) and dyslipidemia (DLP) further increases the risk of CVD in T2DM. Epidemiological data support that T2DM patients without previous myocardial infarction have a similar risk of myocardial infarction as nondiabetic patients with previous myocardial infarction. Aspirin is used for the secondary prevention of CVD, but the efficacy of aspirin for primary prevention in T2DM remains controversial. This article reviewed the recent evidence from three randomized controlled trials (ASCEND, ARRIVE and ASPREE) on the effects of aspirin for primary prevention. These studies showed that aspirin therapy provided a benefit in primary prevention but also increased the risk of serious major bleeding events in diabetic patients. The positive benefits of aspirin in preventing serious vascular events were largely counterbalanced by an increased risk of bleeding. Based on the results of these trials, especially the ASCEND study, the American Diabetes Association’s 2020 Standards of Medical Care in Diabetes recommend the use of aspirin for primary prevention in diabetic patients with an increased cardiovascular risk after a comprehensive discussion with the patient on the benefits versus the comparable increased risk of bleeding.
References
Cho NH, Shaw JE, Karuranga S, et al. IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract. 2018;138:271-281. https://doi.org/10.1016/j.diabres.2018.02.023
Matheus AS de M, Tannus LRM, Cobas RA, Palma CCS, Negrato CA, Gomes M de B. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens. 2013;2013:653789. https://doi.org/10.1155/2013/653789
Emerging Risk Factors Collaboration, Sarwar N, Gao P, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet Lond Engl. 2010;375(9733):2215-2222. https://doi.org/10.1016/S0140-6736(10)60484-9
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HAW. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359(15):1577-1589. https://doi.org/10.1056/NEJMoa0806470
Nathan DM, Cleary PA, Backlund J-YC, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005;353(25):2643-2653. https://doi.org/10.1056/NEJMoa052187
Gaede P, Lund-Andersen H, Parving H-H, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med. 2008;358(6):580-591. https://doi.org/10.1056/NEJMoa0706245
American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):S103-S123. https://doi.org/10.2337/dc19-S010
Paneni F, Beckman JA, Creager MA, Cosentino F. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Eur Heart J. 2013;34(31):2436-2443. https://doi.org/10.1093/eurheartj/eht149
Shoelson SE, Lee J, Goldfine AB. Inflammation and insulin resistance. J Clin Invest. 2006;116(7):1793-1801. https://doi.org/10.1172/JCI29069
Ference BA, Ginsberg HN, Graham I, et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur Heart J. 2017;38(32):2459-2472. https://doi.org/10.1093/eurheartj/ehx144
Patti G, Cavallari I, Andreotti F, et al. Prevention of atherothrombotic events in patients with diabetes mellitus: from antithrombotic therapies to new-generation glucose-lowering drugs. Nat Rev Cardiol. 2019;16(2):113-130. https://doi.org/10.1038/s41569-018-0080-2
Haffner SM, Lehto S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339(4):229-234. https://doi.org/10.1056/NEJM199807233390404
Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002;324(7329):71-86. https://doi.org/10.1136/bmj.324.7329.71
Antithrombotic Trialists’ (ATT) Collaboration, Baigent C, Blackwell L, et al. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet Lond Engl. 2009;373(9678):1849-1860. https://doi.org/10.1016/S0140-6736(09)60503-1
Ogawa H, Nakayama M, Morimoto T, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008;300(18):2134-2141. https://doi.org/10.1001/jama.2008.623
Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ. 2008;337:a1840. https://doi.org/10.1136/bmj.a1840
Saito Y, Okada S, Ogawa H, et al. Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Patients With Type 2 Diabetes Mellitus: 10-Year Follow-Up of a Randomized Controlled Trial. Circulation. 2017;135(7):659-670. https://doi.org/10.1161/CIRCULATIONAHA.116.025760
Ferreiro JL, Angiolillo DJ. Diabetes and antiplatelet therapy in acute coronary syndrome. Circulation. 2011;123(7):798-813. https://doi.org/10.1161/CIRCULATIONAHA.109.913376
Capodanno D, Angiolillo DJ. Aspirin for Primary Cardiovascular Risk Prevention and Beyond in Diabetes Mellitus. Circulation. 2016;134(20):1579-1594. doi:10.1161/CIRCULATIONAHA.116.023164
Ajjan R, Storey RF, Grant PJ. Aspirin resistance and diabetes mellitus. Diabetologia. 2008;51(3):385-390. https://doi.org/10.1007/s00125-007-0898-3
Bhatt DL, Grosser T, Dong J-F, et al. Enteric Coating and Aspirin Nonresponsiveness in Patients With Type 2 Diabetes Mellitus. J Am Coll Cardiol. 2017;69(6):603-612. https://doi.org/10.1016/j.jacc.2016.11.050
Gaziano JM, Brotons C, Coppolecchia R, et al. Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial. Lancet Lond Engl. 2018;392(10152):1036-1046. https://doi.org/10.1016/S0140-6736(18)31924-X
McNeil JJ, Woods RL, Nelson MR, et al. Effect of Aspirin on Disability-free Survival in the Healthy Elderly. N Engl J Med. 2018;379(16):1499-1508. https://doi.org/10.1056/NEJMoa1800722
McNeil JJ, Wolfe R, Woods RL, et al. Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly. N Engl J Med. 2018;379(16):1509-1518. https://doi.org/10.1056/NEJMoa1805819
McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018;379(16):1519-1528. https://doi.org/10.1056/NEJMoa1803955
American Diabetes Association. 9. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S86-S104. https://doi.org/10.2337/dc18-S009
American Diabetes Association. 10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S111-S134. https://doi.org/10.2337/dc20-S010
Downloads
Published
How to Cite
Issue
Section
License
บทความที่ได้รับการตีพิมพ์เป็นลิขสิทธิ์ของราชวิทยาลัยจุฬาภรณ์
ข้อความที่ปรากฏในบทความแต่ละเรื่องในวารสารวิชาการเล่มนี้เป็นความคิดเห็นส่วนตัวของผู้เขียนแต่ละท่านไม่เกี่ยวข้องกับราชวิทยาลัยจุฬาภรณ์ และคณาจารย์ท่านอื่น ในราชวิทยาลัยฯ แต่อย่างใด ความรับผิดชอบองค์ประกอบทั้งหมดของบทความแต่ละเรื่องเป็นของผู้เขียนแต่ละท่าน หากมีความผิดพลาดใด ๆ ผู้เขียนแต่ละท่านจะรับผิดชอบบทความของตนเองแต่ผู้เดียว
