Clinical question In patients with diabetes but no cardiovascular disease, does daily aspirin treatment reduce the risk of cardiovascular events?
Bottom line Aspirin does not reduce the likelihood of cardiovascular events in patients with diabetes without preexisting disease, except to decrease the risk of MI in men. We do not need to specifically target patients with diabetes for aspirin therapy; instead, we can treat them just as we would treat any other patient. (Level of evidence = 1a)
Synopsis Although the concept has been refuted that diabetes confers a similar risk of heart disease as patients who have had a previous MI (Diabet Med. 2009;26[2]:142-148), some groups recommend aspirin be given to all patients with diabetes. The researchers producing this meta-analysis searched two databases, including the Cochrane central register, as well as reference lists of identified articles, limiting their search to English-language articles. Two authors independently identified eligible trials and extracted the data. They identifi ed six trials enrolling a total of 10,117 patients with diabetes and used various dosages of aspirin. The aspirin did not produce any significant reduction in the risk of major cardiovascular events, cardiovascular mortality, or all-cause mortality. Heterogeneity was found among the data of the effect on MI, with men benefitting (relative risk = 0.57; 95% CI, 0.34-0.94) but not women. A similar meta-analysis published at the same time found the relative benefit of aspirin to be similar in patients with and without diabetes (Diabetes Care. 2009;32[12]:2300- 2306).
De Berardis G, Sacco M, Strippoli GF, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. BMJ. 2009;339:b4531.
Levels of evidence in
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