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Aspirin for Primary Prevention of Cardiovascular Disease in Diabetes: a Review of the Evidence

  • Macrovascular Complications in Diabetes (VR Aroda and A Getaneh, Section Editors)
  • Published:
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Abstract

Purpose of Review

People with diabetes are at a higher risk of atherosclerotic cardiovascular disease (ASCVD) compared with those without diabetes. Though aspirin has been shown to have an overall net clinical benefit when used for secondary prevention of ASCVD in people with and without diabetes, the evidence for primary prevention, especially in those with diabetes, remains inconsistent. In this article, we review the latest studies examining the risks and benefits of aspirin use for primary prevention of ASCVD in adults with diabetes, discuss key aspects in assessing the risk-benefit ratio of aspirin use for primary prevention of ASCVD, and summarize current guidelines from professional societies on aspirin use for primary prevention in adults with diabetes.

Recent Findings

In the general population, past studies have shown no difference in the beneficial effect of aspirin for primary cardiovascular disease prevention by diabetes status. However, several randomized controlled studies and meta-analyses in adults with diabetes have shown lack of net clinical benefit of aspirin use for primary prevention of ASCVD. The recent ASCEND trial documented cardiovascular benefit of aspirin for primary prevention in adults with diabetes but suggested that the increased risk of bleeding may outweigh the cardiovascular benefit.

Summary

The decision to initiate aspirin for primary prevention of ASCVD must be considered carefully on an individual basis to balance the cardiovascular benefit and bleeding risk in all patients, especially those with diabetes. A multifactorial approach that focuses on managing ASCVD risk factors such as hypertension, dyslipidemia, dysglycemia, and smoking is recommended in all patients. More research is needed to identify subgroups of people with diabetes who are more likely to benefit from aspirin use for primary prevention of ASCVD and develop better antithrombotic strategies that shift the risk-benefit balance toward an overall net clinical benefit.

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Acknowledgements

The Saudi Government Scholarship from King Saud University, Riyadh, Saudi Arabia provided fellowship training support to Dr. Al-Sofiani. Dr. Kalyani had funding provided by the National Institutes of Health/NIDDK (R03 DK109163).

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Authors and Affiliations

  1. Division of Endocrinology, Diabetes & Metabolism, The Johns Hopkins University, 1830 East Monument Street, Suite 333, Baltimore, MD, 21287, USA

    Mohammed E. Al-Sofiani, Michael Quartuccio & Rita R. Kalyani

  2. Endocrinology Division, College of Medicine, King Saud University, Riyadh, Saudi Arabia

    Mohammed E. Al-Sofiani

  3. General Internal Medicine, The Johns Hopkins University, Baltimore, MD, USA

    Robert Derenbecker

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  1. Mohammed E. Al-Sofiani
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Al-Sofiani, M.E., Derenbecker, R., Quartuccio, M. et al. Aspirin for Primary Prevention of Cardiovascular Disease in Diabetes: a Review of the Evidence. Curr Diab Rep 19, 107 (2019). https://doi.org/10.1007/s11892-019-1206-6

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