Meta-analysis Of Aspirin In Primary Prevention Of Cardiovascular Events In Patients With Diabetes

ObjectiveIn diabetics, mortality and morbidity for cardiovascular events is 2 to 4 fold greater than patients without diabetes. The use of aspirin for primary prevention of cardiovascular events in patients with diabetes is widely recommended by many existing guidelines. Aspirin acts as a protected drug in the cardiovascular events in the non-diabetics. However, the question of whether aspirin reduces the risk for cardiovascular disease in persons without known cardiovascular disease is controversial. With the order to better evaluate the role of aspirin, a meta-analysis of aspirin therapy for the primary prevention of cardiovascular events in diabetic patients is performed.MethodsDatabase search of MEDLINE, EMBASE, Cochrane Controlled Trials Register, VIP Database, CNKI, CBM disc (from the date of database establishment to July 2009) was carried out. The key words included diabetes, hyperglycemia, aspirin, acetylsalicylic acid hydrolase, non-steroidal anti-inflammatory drugs (NSAIDS), primary prevention, cardiovascular diseases, myocardial infarction, and stroke. No language restriction was applied. Additional studies were retrieved via references of the articles and directed conduct of authors to possess relevant data. Prospective randomized controlled trials without previous history of cardiovascular disease in diabetic patients were selected. Quality of all the studies was evaluated, and the data which met the inclusion criteria were extracted. Review Manager Software 5.0 was used for statistical analysis. ResultsFour trials with a total of 5883 participants were included. The meta-analysis showed that aspirin was associated with 30% reduction in stroke (RR=0.71,95% CI 0.55 to 0.93, P=0.01), but no significant effect on major cardiovascular events (RR=0.90,95% CI 0.77 to 1.04,P=0.15) or myocardial infarctions (RR=1.02,95% CI 0.78 to 1.32, P=0.90) was found, and no sex-specific difference was identified. Aspirin increased more than 4 odds of bleeding events compared with the control group (RR=4.03,95% CI 2.09 to 7.78, P<0.0001). There was no significant difference between the aspirin group and the control group in cardiovascular mortality (RR=0.85, 95% CI 0.32 to 2.24, P=0.74) and major mortality (RR=0.87,95% CI 0.47 to 1.61, P=0.67).ConclusionsFindings from this meta-analysis suggest that low-dose aspirin therapy could significantly reduce the risk of stroke, although increasing the risk of bleeding in diabetic patients.