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Meta-Analysis
. 2020 Dec;27(19):2034-2041.
doi: 10.1177/2047487319825510. Epub 2019 Jan 30.

Aspirin for primary prevention of cardiovascular outcomes in diabetes mellitus: An updated systematic review and meta-analysis

Safi U Khan  1 , Zain Ul Abideen Asad  2 , Muhammad U Khan  1 , Swapna Talluri  3 , Farman Ali  4 , Muhammad Shahzeb Khan  5 , Ahmad N Lone  1 , Farouk Mookadam  6 , Richard A Krasuski  7 , Edo Kaluski  8
Affiliations
Meta-Analysis

Aspirin for primary prevention of cardiovascular outcomes in diabetes mellitus: An updated systematic review and meta-analysis

Safi U Khan et al. Eur J Prev Cardiol. 2020 Dec.

Abstract

Background: The safety and efficacy of aspirin for the primary prevention of cardiovascular disease in patients with diabetes mellitus remains controversial.

Design: A meta-analysis to investigate the effects of aspirin for the prevention of cardiovascular disease in diabetes mellitus.

Methods: Ten randomized controlled trials were selected using MEDLINE, EMBASE and CENTRAL databases until 27 September 2018. Risk ratios (RRs) with 95% confidence intervals (CIs) and risk differences (RDs) reported as incident events per 1000 person-years were calculated.

Results: In 33,679 patients, aspirin did not significantly reduce the risk of major adverse cardiovascular outcomes (RR 0.93, 95% CI 0.87-1.00, P = 0.06; RD -0.68 incident cases per 1000 person-years (95% CI -1.54, 0.17)), cardiovascular mortality (RR 0.95, 95% CI 0.83-1.09, P = 0.49; RD 0.11 incident cases per 1000 person-years (95% CI -0.80, 1.02)), myocardial infarction (RR 0.91, 95% CI 0.75-1.11, P = 0.36; RD -0.66 incident cases per 1000 person-years (95% CI -2.07, 0.75)), or stroke (RR 0.91, 95% C, 0.76-1.10, P = 0.33; RD -0.55 incident cases per 1000 person-years (95% CI -1.57, 0.47)). There was a significantly higher risk of total bleeding associated with aspirin (RR 1.29, 95% CI 1.07-1.55, P = 0.01; RD 1.49 incident cases per 1000 person-years (95% CI 0.36, 2.61)).

Conclusion: The use of aspirin for primary prevention of cardiovascular disease in patients with diabetes mellitus increases the risk of total bleeding without reducing the risk of major adverse cardiovascular outcomes.

Keywords: Cardiovascular disease; aspirin; diabetes mellitus; primary prevention.

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Conflict of interest statement

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA flow chart showing study selection process.
Figure 2.
Figure 2.
Forest plot comparing aspirin versus control for major adverse cardiovascular events (MACEs), cardiovascular mortality, myocardial infarction (MI) and stroke.
Figure 3.
Figure 3.
Forest plot comparing aspirin versus control for safety outcomes.
See this image and copyright information in PMC

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