Published in:
01-03-2008 | Commentary
Aspirin resistance and diabetes mellitus
Authors:
R. Ajjan, R. F. Storey, P. J. Grant
Published in:
Diabetologia
|
Issue 3/2008
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Excerpt
Despite multiple interventions to reduce the risk of cardiovascular disease, the majority of people with diabetes develop macrovascular complications, and mortality following myocardial infarction remains unacceptably high [
1]. Antiplatelet agents are used for both the primary and secondary prevention of cardiovascular disease, although current guidelines are not consistent in their recommendation for the use of aspirin in diabetes [
2]. In fact, there is little direct evidence supporting its efficacy in this group of patients. Instead, there is convincing data in the literature to suggest inadequate cardiovascular protection by aspirin in diabetes. In a meta-analysis of 287 randomised trials, antiplatelet treatment (aspirin in most studies) reduced the risk of ischaemic events by 22%, but the risk reduction in the subgroup with diabetes was only 7%, which was not statistically significant [
3]. This outcome was mirrored in the Primary Prevention Project trial, which reported that cardiovascular risk reduction with aspirin was marginal and non-significant in the presence of diabetes [
4]. Despite this, there are no published studies specifically designed to evaluate the clinical efficacy of aspirin in individuals with diabetes, a surprising omission in the era of ‘evidence-based’ medicine. …
