Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Feb;34(2):280-5.
doi: 10.2337/dc10-1615.

Low-dose aspirin therapy in patients with type 2 diabetes and reduced glomerular filtration rate: subanalysis from the JPAD trial

Yoshihiko Saito  1 , Takeshi Morimoto, Hisao Ogawa, Masafumi Nakayama, Shiro Uemura, Naofumi Doi, Hideaki Jinnouchi, Masako Waki, Hirofumi Soejima, Seigo Sugiyama, Sadanori Okada, Yasuhiro Akai; Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes Trial Investigators
Collaborators, Affiliations
Randomized Controlled Trial

Low-dose aspirin therapy in patients with type 2 diabetes and reduced glomerular filtration rate: subanalysis from the JPAD trial

Yoshihiko Saito et al. Diabetes Care. 2011 Feb.

Abstract

Objective: Type 2 diabetes accompanied by renal damage is a strong risk factor for atherosclerotic events. The purpose of this study was to investigate the efficacy of low-dose aspirin therapy on primary prevention of atherosclerotic events in patients with type 2 diabetes and coexisting renal dysfunction.

Research design and methods: The Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial was a prospective, randomized, open-label trial conducted throughout Japan that enrolled 2,539 type 2 diabetic patients without a history of atherosclerotic diseases. Patients were assigned to the aspirin group (81 mg/day or 100 mg/day) or the nonaspirin group and followed for a median of 4.37 years. The primary end points were atherosclerotic events of fatal and nonfatal ischemic heart disease, stroke, and peripheral arterial disease.

Results: The analysis included 2,523 patients who had serum creatinine measured. In 1,373 patients with baseline estimated glomerular filtration rate (eGFR) 60-89 mL/min/1.73 m(2), the incidence of primary end points was significantly lower in the aspirin group than in the nonaspirin group (aspirin, 30/661; nonaspirin, 55/712; hazard ratio 0.57 [95% CI 0.36-0.88]; P = 0.011). Low-dose aspirin therapy did not reduce primary end points in patients with eGFR ≥ 90 mL/min/1.73 m(2) (aspirin, 9/248; nonaspirin, 11/270; 0.94 [0.38-2.3]) or those with eGFR <60 mL/min/1.73 m(2) (aspirin, 29/342; nonaspirin, 19/290; 1.3 [0.76-2.4]). The Cox proportional hazard model demonstrated a significant interaction between mild renal dysfunction (eGFR 60-89 mL/min/1.73 m(2)) and aspirin (P = 0.02).

Conclusions: These results suggest a differential effect of low-dose aspirin therapy in diabetic patients with eGFR 60-89 mL/min/1.73 m(2).

Trial registration: ClinicalTrials.gov NCT00110448.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percentage of primary end points by category of patients with eGFR of at least 90 mL/min/1.73 m2 (A), 60–89 mL/min/1.73 m2 (B), or <60 mL/min/1.73 m2 (C).
Figure 2
Figure 2
Subgroup analysis of incidence of primary end points.
See this image and copyright information in PMC

References

    1. Pignone M, Alberts MJ, Colwell JA, et al. American Diabetes Association. American Heart Association. American College of Cardiology Foundation Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Diabetes Care 2010;33:1395–1402 - PMC - PubMed
    1. Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001;134:629–636 - PubMed
    1. Anavekar NS, Solomon SD, McMurray JJ, et al. Comparison of renal function and cardiovascular risk following acute myocardial infarction in patients with and without diabetes mellitus. Am J Cardiol 2008;101:925–929 - PubMed
    1. Ekundayo OJ, Muchimba M, Aban IB, Ritchie C, Campbell RC, Ahmed A. Multimorbidity due to diabetes mellitus and chronic kidney disease and outcomes in chronic heart failure. Am J Cardiol 2009;103:88–92 - PMC - PubMed
    1. National Kidney Foundation K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Am J Kidney Dis 2002;39(Suppl. 1):S1–S266 - PubMed

Publication types

MeSH terms

Associated data