Abstract 12166: Efficacy of Low-dose Aspirin Therapy for Primary Prevention of Atherosclerotic Events Depends on the Severity of Diabetes: a subanalysis of JPAD trial
Many guidelines recommend that low-dose aspirin therapy for primary prevention of atherosclerotic events in diabetic patients with high risk. However, recent meta-analyses did not show its efficacy for primary prevention in patients with diabetes mellitus. JPAD trial was a randomized, controlled, open-label blinded-endpoint study to examine efficacy of low-dose aspirin therapy for primary prevention of atherosclerotic events. It enrolled 2539 Japanese patients with type 2 diabetes mellitus, and followed for a median 4.37 years. In JPAD trial, we demonstrated that aspirin therapy did not reduce atherosclerotic events. In a post-hoc analysis, we hypothesized that aspirin effect depended on the therapeutic regimen of diabetes, which indicated the severity of diabetes. We analyzed the differences in the therapeutic regimen of diabetes at baseline: insulin (n= 326), oral hypogrlycemic agent (OHA) (n =1750), and diet therapy (n = 463) groups. The insulin group had the longest duration of diabetes and the highest level of hemoglobin A1C, fasting plasma glucose, and the highest prevalence of diabetic microangiopathies. In contrast, the diet group had the opposite characteristics. The incidence of atherosclerotic events was 26.6, 14.6, and 10.4 cases per 1000 person-years in the insulin, OHA, and diet therapy groups, respectively. In the insulin and OHA groups, aspirin therapy did not affect atherosclerotic events (Insulin group: hazard ratio [HR], 1.19; 95% confidence interval [CI], 0.60–2.40; OHA group: HR, 0.84; 95%CI, 0.57–1.24). On the other hand, in the diet therapy group, aspirin therapy significantly reduced atherosclerotic events in spite of the lowest event rates (Figure, HR: 0.21, 95%CI: 0.05–0.64). In Conclusions, low-dose aspirin therapy reduced atherosclerotic events only in the diet therapy group, early stage of diabetes.
- © 2010 by American Heart Association, Inc.