Moderate-dose aspirin linked to lower all-cause mortality in diabetics
MedWire News: Results from a meta-analysis show that moderate-dose aspirin can significantly reduce all-cause mortality in diabetic patients.
Low-dose aspirin is recommended for cardiovascular (CV) risk reduction in at-risk patients with Type 2 diabetes, but there has been some debate about the ideal dosage to use, and recent studies, such as JPAD (Japanese Primary prevention of atherosclerosis with Aspirin for Diabetes) and POPADAD (Prevention Of Progression of Arterial Disease And Diabetes), indicate that a daily dose of 100 mg/dl or less is not effective for primary prevention.
Scott Simpson (University of Alberta, Edmonton, Canada) and colleagues performed a meta-analysis to estimate the optimum aspirin dose required to achieve a significant reduction in all-cause mortality in diabetic patients. In total, 21 studies involving 17,522 diabetic patients were included in the analysis.
Overall, 14.6% (1189 of 8133) of patients who took aspirin and 17.0% (1358 of 8000) of those who did not died. Simpson and team found that aspirin use was not associated with a statistically significant reduction in mortality risk in the pooled cohort, and stratification by daily aspirin dose only led to small decreases in pooled risk ratios.
However, patients with a history of CV disease who were taking aspirin achieved a significant 18% reduction in mortality risk, compared with their peers not taking aspirin.
Further stratification for aspirin dose in patients with a history of CV disease showed that only patients taking aspirin 325 mg/day or more achieved a significant reduction in all-cause mortality (23%). When only randomized controlled trials were considered, however, patients given aspirin 101-325 mg/dl had a significant reduction in mortality risk.
"The premise of this study is coming from a pharmacologic study called ASPECT, where patients with diabetes that were using 81 mg of aspirin had a higher rate of aspirin resistance compared with those that were using over 100 mg of aspirin daily," explained Simpson, who presented the results at the American Diabetes Association 2010 Scientific Sessions held in Orlando, Florida.
"We wanted to see if that would translate into clinical outcomes of cardiovascular events or all-cause mortality."
He suggested that the dose-response relationship seen in this analysis should be investigated further in a clinical trial.
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By Helen Albert