Should We Prescribe Statin and Aspirin for Every Diabetic Patient?

There is clear evidence that diabetic patients constitute a group at high cardiovascular risk. Epidemiologic data show that with the aging of the European population, the percentage of diabetic patients will increase in the upcoming years, with important consequences for cardiovascular mortality. Therefore, the question arises, “How aggressive should prevention with statins and aspirin in diabetic patients be?” As several studies have demonstrated, cardiovascular mortality of diabetic patients is as high as in nondiabetic patients with known coronary artery disease (1–3); thus, the term “coronary artery disease risk equivalent” has been introduced. A coronary artery disease risk equivalent implicates the need for stronger treatment goals of secondary prevention for cardiovascular risk factors. A further debate is whether medical treatment provided to patients with coronary heart disease should also be given to diabetic patients without known coronary heart disease. Aspirin administration as secondary prevention in coronary heart disease is well established. The beneficial effect of aspirin therapy in secondary prevention of coronary heart disease has been demonstrated by the meta-analysis of the Antithrombotic Trialist’ Collaboration in 2002, with a total relative risk reduction of 15% for cardiovascular death and of 28% for nonfatal re-infarction (4) (Fig. 1). Figure 1— Beneficial effect of aspirin in secondary coronary prevention. Adapted from Antithrombotic Trialists’ Collaboration (4). *Vascular events: death from vascular causes, nonfatal myocardial infarction, and nonfatal stroke. MI, myocardial infarction; pts., patients; TIA, transient ischemic attack. Regarding primary prevention, Ridker et al. (5) showed a risk reduction by aspirin of 26% for a first cardiovascular event in women ≥65 years of age. In a meta-analysis of primary prevention, Patrono et al. (6) demonstrated that with increasing cardiovascular risk, the benefit of aspirin therapy increases without an increase of bleeding complications; the benefit-risk profile of aspirin becomes more beneficial with increasing cardiovascular risk, …