Mohammed E Al-Sofiani1,2, Robert Derenbecker3, Michael Quartuccio1, Rita R Kalyani4. 1. Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA. 2. Endocrinology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia. 3. General Internal Medicine, The Johns Hopkins University, Baltimore, MD, USA. 4. Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA. rrastogi@jhmi.edu.
Abstract
PURPOSE OF REVIEW: People with diabetes are at a higher risk of atherosclerotic cardiovascular disease (ASCVD) compared with those without diabetes. Though aspirin has been shown to have an overall net clinical benefit when used for secondary prevention of ASCVD in people with and without diabetes, the evidence for primary prevention, especially in those with diabetes, remains inconsistent. In this article, we review the latest studies examining the risks and benefits of aspirin use for primary prevention of ASCVD in adults with diabetes, discuss key aspects in assessing the risk-benefit ratio of aspirin use for primary prevention of ASCVD, and summarize current guidelines from professional societies on aspirin use for primary prevention in adults with diabetes. RECENT FINDINGS: In the general population, past studies have shown no difference in the beneficial effect of aspirin for primary cardiovascular disease prevention by diabetes status. However, several randomized controlled studies and meta-analyses in adults with diabetes have shown lack of net clinical benefit of aspirin use for primary prevention of ASCVD. The recent ASCEND trial documented cardiovascular benefit of aspirin for primary prevention in adults with diabetes but suggested that the increased risk of bleeding may outweigh the cardiovascular benefit. The decision to initiate aspirin for primary prevention of ASCVD must be considered carefully on an individual basis to balance the cardiovascular benefit and bleeding risk in all patients, especially those with diabetes. A multifactorial approach that focuses on managing ASCVD risk factors such as hypertension, dyslipidemia, dysglycemia, and smoking is recommended in all patients. More research is needed to identify subgroups of people with diabetes who are more likely to benefit from aspirin use for primary prevention of ASCVD and develop better antithrombotic strategies that shift the risk-benefit balance toward an overall net clinical benefit.
PURPOSE OF REVIEW: People with diabetes are at a higher risk of atherosclerotic cardiovascular disease (ASCVD) compared with those without diabetes. Though aspirin has been shown to have an overall net clinical benefit when used for secondary prevention of ASCVD in people with and without diabetes, the evidence for primary prevention, especially in those with diabetes, remains inconsistent. In this article, we review the latest studies examining the risks and benefits of aspirin use for primary prevention of ASCVD in adults with diabetes, discuss key aspects in assessing the risk-benefit ratio of aspirin use for primary prevention of ASCVD, and summarize current guidelines from professional societies on aspirin use for primary prevention in adults with diabetes. RECENT FINDINGS: In the general population, past studies have shown no difference in the beneficial effect of aspirin for primary cardiovascular disease prevention by diabetes status. However, several randomized controlled studies and meta-analyses in adults with diabetes have shown lack of net clinical benefit of aspirin use for primary prevention of ASCVD. The recent ASCEND trial documented cardiovascular benefit of aspirin for primary prevention in adults with diabetes but suggested that the increased risk of bleeding may outweigh the cardiovascular benefit. The decision to initiate aspirin for primary prevention of ASCVD must be considered carefully on an individual basis to balance the cardiovascular benefit and bleeding risk in all patients, especially those with diabetes. A multifactorial approach that focuses on managing ASCVD risk factors such as hypertension, dyslipidemia, dysglycemia, and smoking is recommended in all patients. More research is needed to identify subgroups of people with diabetes who are more likely to benefit from aspirin use for primary prevention of ASCVD and develop better antithrombotic strategies that shift the risk-benefit balance toward an overall net clinical benefit.
Authors: M A Bethel; P Harrison; H Sourij; Y Sun; L Tucker; I Kennedy; S White; L Hill; A Oulhaj; R L Coleman; R R Holman Journal: Diabet Med Date: 2015-07-14 Impact factor: 4.359
Authors: David C Calverley; Michele R Hacker; Kimberly A Loda; Elizabeth Brass; Thomas A Buchanan; Denice D Tsao-Wei; Susan Groshen Journal: Br J Haematol Date: 2003-04 Impact factor: 6.998
Authors: Brian F Gage; Yan Yan; Paul E Milligan; Amy D Waterman; Robert Culverhouse; Michael W Rich; Martha J Radford Journal: Am Heart J Date: 2006-03 Impact factor: 4.749
Authors: Paul A Gurbel; Kevin P Bliden; Joseph DiChiara; Justin Newcomer; Willy Weng; Nagaraj K Neerchal; Tania Gesheff; Srivasavi K Chaganti; Amena Etherington; Udaya S Tantry Journal: Circulation Date: 2007-06-11 Impact factor: 29.690
Authors: L Hansson; A Zanchetti; S G Carruthers; B Dahlöf; D Elmfeldt; S Julius; J Ménard; K H Rahn; H Wedel; S Westerling Journal: Lancet Date: 1998-06-13 Impact factor: 79.321
Authors: G Michael Allan; Faeze Nouri; Christina Korownyk; Michael R Kolber; Ben Vandermeer; James McCormack Journal: Circulation Date: 2013-04-10 Impact factor: 29.690
Authors: Elizabeth Y Liu; Mohammed E Al-Sofiani; Hsin-Chieh Yeh; Justin B Echouffo-Tcheugui; Joshua J Joseph; Rita R Kalyani Journal: JAMA Netw Open Date: 2021-06-01