Aspirin significantly reduced the risk of major adverse cardiovascular events (OR 0.89) compared to control in patients with diabetes, without significantly reducing all-cause mortality or increasing bleeding events.
Meta-Analysis (n=32,024)
Does aspirin reduce cardiovascular events and mortality in adults with diabetes without prior cardiovascular disease?
In adults with diabetes without prior cardiovascular disease, aspirin significantly reduces the risk of major adverse cardiovascular events without a statistically significant increase in bleeding, though bleeding definitions across studies were highly heterogeneous.
Effect estimate: OR 0.89 (95% CI 0.82-0.96)
p-value: p=0.003
Purpose: A meta-analysis was conducted to assess the benefits and risks of aspirin for the primary prevention of cardiovascular disease and all-cause mortality events in adults with diabetes. Methods: An extensive and systematic search was conducted in MEDLINE (via PubMed), Cinahl (via Ebsco), Scopus, and Web of Sciences from 1988 to December 2020. A detailed literature search was conducted using aspirin, cardiovascular disease (CVD), diabetes, and efficacy to identify trials of patients with diabetes who received aspirin for primary prevention of CVD. Demographic details with the primary outcome of events and bleeding outcomes were analyzed. The Cochrane Collaboration's risk of bias tool was used to assess the methodological quality of the included studies. Random-effects meta-analysis was used to calculate the pooled odds ratio for outcomes of cardiovascular events, death, and adverse events. Findings: A total of 8 studies were included with 32,024 patients with diabetes; 16,001 allocated to aspirin, and 16,023 allocated to the control group. There was no difference between aspirin and control groups with respect to all-cause mortality, cardiovascular mortality, or bleeding events. However, MACE was significantly lower in the aspirin group. Implications: Although aspirin has no significant risk on primary endpoints of cardiovascular events and bleeding outcomes in patients with diabetes compared to control, major adverse cardiovascular events (MACE) were significantly lower in the aspirin group. Further research on the use of aspirin alone or in combination with other antiplatelet drugs is required in patients with diabetes to supplement currently available research. Systematic Review Registration: identifier XU#/IRB/2020/1005.
Ma et al. (2021) conducted a meta-analysis in Diabetes without prior cardiovascular disease (n=32,024). Aspirin vs. Placebo or no treatment was evaluated on Major adverse cardiovascular events (MACE) (OR 0.89, 95% CI 0.82-0.96, p=0.003). Aspirin significantly reduced the risk of major adverse cardiovascular events (OR 0.89) compared to control in patients with diabetes, without significantly reducing all-cause mortality or increasing bleeding events.