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Recommendation
| Note that patients with diabetes have similar relative benefits on CVD protection with ASA treatment as those without diabetes, but their absolute benefit may be greater due to their greater baseline risk of CVD.
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Evidence:
- A meta-analysis of 145 randomized controlled trials of antiplatelet therapy for secondary prevention of cardiovascular events found that participants with diabetes had an equivalent 25% reduction in cardiovascular events as did those without diabetes (124).
- The Early Treatment Diabetic Retinopathy Study of type 1 and type 2 diabetes patients, 52% of whom had no previous CVD, found that ASA treatment significantly reduced the risk of MI by 28% over 5 years (125).
- For primary prevention of cardiovascular events, aspirin treatment was associated with a 15% cardiovascular event reduction (NNT, 63) in the HOT trial (89), and a 44% reduction in MI rates in participants over age 50 in the Physicians' Health Study (NNT, 54) (126). Both of these studies included over 1500 patients with diabetes.
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Comments:
- The baseline risk of CVD is two to three times higher in persons with diabetes compared to those without diabetes.
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| Denice S. Feig, MD, MSc, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Lorraine Lipscombe, MD, FRCPC has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Sonal Singh, MD, editorial consultant, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.
Steven E. Weinberger, MD, FACP, Acting Editor, PIER, has stock holdings in Glaxosmithkline and Abbott. |
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Screening for Type 2 Diabetes
> Effectiveness/Harms of Early Treatment
