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.

MedWire (www.medwire-news.md) is an independent clinical news
service provided by Current Medicine Group, a trading division of
Springer Healthcare Limited. © Springer Healthcare Ltd;
2010

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