Should aspirin be used for the primary prevention of cardiovascular disease in people with diabetes?

Woods, Robyn L; Tonkin, Andrew M; Nelson, Mark R; Britt, Helena C; Reid, Christopher M

doi:10.5694/j.1326-5377.2009.tb02587.x

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Robust evidence remains to be gathered

Whenever possible, clinical decision making should be evidence-based. In reality, the evidence may be incomplete and the practitioner must use personal clinical judgement. This should be based on recommendations or guidelines provided by authoritative groups.

1 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
2 Menzies Research Institute, University of Tasmania, Hobart, TAS.
3 Australian General Practice Statistics and Classification Centre, School of Public Health, University of Sydney, Sydney, NSW.

Correspondence: robyn.woods@med.monash.edu.au

Competing interests:

Andrew Tonkin, Mark Nelson and Christopher Reid have received support from Bayer HealthCare (a manufacturer of aspirin) for their ongoing NHMRC-supported ASPREE trial. Bayer HealthCare provided an educational grant (US$250 000) and is now supplying aspirin and placebo for ASPREE.

1. Diabetes Australia and Royal Australian College of General Practitioners. Diabetes management in general practice. Guidelines for type 2 diabetes 2008/9. Canberra: Diabetes Australia, 2008. (Diabetes Australia Publication NP 1055.) http://www.racgp.org.au/Content/NavigationMenu/ClinicalResources/RACGPGuidelines/Diabetesmanagement/ 2008DiabetesManagementInGeneralPractice.pdf (accessed Apr 2009).
2. National Health and Medical Research Council. National evidence based guidelines for the management of type 2 diabetes mellitus. Part 5. Prevention and detection of macrovascular disease in type 2 diabetes. Canberra: NHMRC, 2004. http://www.nhmrc.gov.au/publications/synopses/_files/di11.pdf (accessed Apr 2009).
3. Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 136: 161-172.
4. Colwell JA, American Diabetes Association. Aspirin therapy in diabetes. Diabetes Care 2004; 27 Suppl 1: 72-73.
5. British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, endorsed by the British Diabetic Association. Joint British recommendations on prevention of coronary heart disease in clinical practice. Heart 1998; 80 Suppl 2: 1-9.
6. British Cardiac Society, British Hyperlipidaemia Association, British Hypertension Society, British Diabetic Association. Joint British recommendations on prevention of coronary heart disease in clinical practice: summary. BMJ 2000; 320: 705-708.
7. International Diabetes Federation. Global guideline for type 2 diabetes. Brussels: IDF, 2005. http://www.idf.org/home/index.cfm?node=1457 (accessed Apr 2009).
8. Donnan PT, Donnelly L, New JP, Morris AD. Derivation and validation of a prediction score for major coronary heart disease events in a UK type 2 diabetic population. Diabetes Care 2006; 29: 1231-1236.
9. Britt H, Miller GC, Henderson J, Bayram C. Patient-based substudies from BEACH: abstracts and research tools 1999–2006. General practice series no. 20. Canberra: Australian Institute of Health and Welfare, 2007. (AIHW Cat. No. GEP 20; abstract item 94.) http://www.aihw.gov.au/publications/index.cfm/title/10473 (accessed Apr 2009).
10. Britt H, Miller GC, Charles J, et al. General practice activity in Australia 2007–08. General practice series no. 22. Canberra: Australian Institute of Health and Welfare, 2008. (AIHW Cat. No. GEP 22; abstract item 115.) http://www.aihw.gov.au/publications/index.cfm/title/10651 (accessed Apr 2009).
11. Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008; 337: a1840.
12. Ogawa H, Nakayama M, Morimoto T, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA 2008; 300: 2134-2141.
13. Swan N. Aspirin for the prevention of heart attack [radio transcript]. The health report. Radio National. Australian Broadcasting Corporation. 27 October 2008. http://www.abc.net.au/rn/healthreport/stories/2008/2399279.htm (accessed Apr 2009).
14. Nicolucci A. Aspirin for primary prevention of cardiovascular events in diabetes [editorial]. JAMA 2008; 300: 2180-2181.
15. Farkouh ME, Fuster V. Diabetes and aspirin: beware of underpowered negative trials [editorial]. Nat Clin Pract Cardiovasc Med 2009; 6: 1.
16. ASCEND: A Study of Cardiovascular Events iN Diabetes. http://clinicaltrials.gov/ct2/show/NCT00135226?spons=%22University+of+Oxford %22&spons_ex=Y&rank=8 (accessed Apr 2009).
17. Nelson MR, Reid CM, Ames DA, et al. Feasibility of conducting a primary prevention trial of low-dose aspirin for major adverse cardiovascular events in older people in Australia: results from the ASPirin in Reducing Events in the Elderly (ASPREE) pilot study. Med J Aust 2008; 189: 105-109. <MJA full text>

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Should aspirin be used for the primary prevention of cardiovascular disease in people with diabetes?

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