In aspirin-treated patients with type 2 diabetes mellitus, hypoalbuminemia (<3.5 g/dL) was associated with an increased risk of cardiovascular events (HR 1.887) compared to normal albumin levels.
Cohort (n=612)
No
Does hypoalbuminemia (<3.5 g/dL) reduce the clinical efficacy of aspirin in preventing cardiovascular events in patients with type 2 diabetes mellitus?
Hazard Ratio: 1.887 (95% CI 1.136–3.135)
Absolute Event Rate: 4.39% vs 2.24%
p-value: p=0.014
Objective: To investigate the impact of albumin levels on the aspirin efficacy, since aspirin inhibits platelet aggregation (PA) by cyclooxygenase one irreversible acetylation that is less effective in patients with type 2 diabetes mellitus (T2DM). Patients and Methods: A total of 612 aspirin (100 mg/day)-treated T2DM patients were followed-up for 54.4 ± 7.3 months. The primary endpoint, a composite of cardiovascular events (CVEs) including CV death, myocardial infarction, ischemic stroke and coronary revascularization, was analysed according to baseline values of serum albumin (≥ or 3.5 g/dL). Serum thromboxane (Tx)B 2 was also measured. Results: 250 (40.8%) patients had serum albumin 3.5 g/dL; these patients were overweight and had higher values of fibrinogen ( p = 0.009), high sensitivity C-reactive protein ( p = 0.001) and fasting plasma glucose ( p 0.0001) compared to those with albumin ≥ 3.5 g/dL. During follow-up, 86 CVEs were recorded, 49 and 37 in patients with serum albumin or ≥3.5 g/dL, respectively ( p = 0.001). At multivariable Cox regression analysis, serum albumin 3.5 g/dL (hazard ratio HR 1.887, 95% confidence interval CI 1.136–3.135, p = 0.014), age (HR 1.552 for every 10 years, 95%CI 1.157–2.081, p = 0.003), fasting plasma glucose (HR 1.063, 95%CI 1.022–1.105, p = 0.002) and beta-blocker use (HR 0.440, 95%CI 0.270–0.717, p = 0.001) were associated to CVEs. Serum TxB 2 levels ( n = 377) were 0.32 ± 0.12 and 0.24 ± 0.12 ng/ml in patients with albumin or ≥ 3.5 g/dL, respectively ( p 0.001). Conclusion: In T2DM patients, the efficacy of aspirin varies according to albumin levels. Hypoalbuminemia associated with impaired TxB 2 inhibition and an increased risk of long-term CVEs.
Sciacqua et al. (Tue,) conducted a cohort in Type 2 Diabetes Mellitus (n=612). Serum albumin < 3.5 g/dL vs. Serum albumin ≥ 3.5 g/dL was evaluated on Composite of cardiovascular events (CVEs) including CV death, myocardial infarction, ischemic stroke and coronary revascularization (HR 1.887, 95% CI 1.136-3.135, p=0.014). In aspirin-treated patients with type 2 diabetes mellitus, hypoalbuminemia (<3.5 g/dL) was associated with an increased risk of cardiovascular events (HR 1.887) compared to normal albumin levels.