Letters
Cardiovascular diseases Endocrinology General medicine
Volume 191 - Issue 6

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

Authors:  Robyn L Woods, Mark R Nelson, Andrew M Tonkin and Christopher M Reid

Med J Aust 2009; 191 (6): 356-357. || doi: 10.5694/j.1326-5377.2009.tb02827.x
Published online: 21 September 2009
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In reply: Recruitment to clinical trials through general practice is representative of the population, as a high proportion of all Australians regularly attend their general practitioners.1 GP co-investigators are appropriate to decide whether their patients are suitable for the ASPREE (ASPirin in Reducing Events in the Elderly) study because their assessment includes objective inclusion and exclusion criteria that must be satisfied before enrolment in the study (clinical trial registration number ISRCTN83772183),2 as well as patient-specific potential risks with using aspirin, and known medical factors likely to influence patient survival during the trial. These include the risk of complicated peptic ulcer disease in patients with diabetes treated with a sulfonylurea.3 GP co-investigators support participation in ASPREE by eligible patients because of aspirin’s therapeutic equipoise for primary prevention in older patients4 and in those with diabetes.5

Because of age alone, ASPREE participants will be at least at intermediate risk of cardiovascular disease and also at increased risk of bleeding. Determining the aspirin balance underpins the importance of collecting more data in older people, who have been under-represented in previous primary prevention trials.

ASPREE is a superiority trial with pre-specified subgroup analyses, including for the subgroup with diabetes.2 The study is powered to address the primary question reliably in the total cohort rather than subgroups. To date, fewer than 500 participants have been randomly allocated, with recruitment slowed subject to National Institutes of Health funding deliberations. Recruitment will be reinvigorated in late 2009, and will continue to include people with diabetes.

Authors

  • Robyn L Woods1
  • Mark R Nelson2
  • Andrew M Tonkin1
  • Christopher M Reid1
  • 1. Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC.
  • 2. Menzies Research Institute, University of Tasmania, Hobart, TAS.

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

References

View this article on Wiley Online Library

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