No Proven Cardiac Benefit for Aspirin in Diabetes

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People with diabetes are at a high risk for cardiovascular disease.Most major medical society guidelines recommend aspirin for primary prevention of cardiovascular events in people with diabetes.

These guidelines are based on evidence from clinical trials showing the benefit of aspirin in patients who are at a high risk of cardiovascular disease. However, Italian researchers recently concluded that there is not sufficient evidence to prove a clear benefit of aspirin in preventing major cardiovascular events in people with diabetes. Their findings were published online November 6, 2009 in the journal BMJ.

Scientists reviewed the literature, looking specifically at six trials comparing aspirin with placebo or no aspirin in over 10,000 people with diabetes who had not been diagnosed with cardiovascular disease. When they combined all of the data from these six trials, the researchers found no statistically significant differences in the risk of major cardiovascular events, cardiovascular death, all-cause death, heart attack, or stroke in people with diabetes who were treated with aspirin. They did find that men, but not women, with diabetes who took aspirin had a 43 percent reduced risk of heart attack.

The analysis also showed inconsistent evidence related to the harms of aspirin treatment in people with diabetes. Based on their findings, the researchers suggest that physicians need to very carefully select the diabetes patients who are more likely to benefit from aspirin.