Does Aspirin Prevent Heart Attack in Patients with Diabetes?

The British Medical Journal concluded that their research does "not provide evidence to support the use of aspirin in primary prevention of cardiovascular events and mortality."

The authors of study results published recently the British Medical Journal concluded that their research does “not provide evidence to support the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality” in patients with diabetes mellitus and asymptomatic peripheral arterial disease.

A team of Scottish researchers enrolled “1,276 adults aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease” and assigned them to one of four study arms:

• Daily, 100mg aspirin tablet plus antioxidant capsule (n=320)

• Daily 100mg aspirin plus placebo (n=318)

• Daily placebo plus antioxidant capsule (n=320)

• Daily placebo plus placebo capsule (n=318)

The study was designed to measure two “hierarchical composite primary end points: death from coronary heart disease or stroke, non-fatal myocardial infarction or stroke, or amputation above the ankle for critical limb ischaemia; and death from coronary heart disease or stroke.”

The authors reported that “116 of 638 primary events occurred in the aspirin groups compared with 117 of 638 in the no aspirin groups.” They also reported 43 deaths from coronary heart disease or stroke in the aspirin groups, compared with 35 in the no-aspirin groups. One hundred seventeen of 640 (18.3%) primary events occurred among the antioxidant groups, compared with 116 of 636 (18.2%) in the no-antioxidant groups. Forty-two (6.6%) deaths from coronary heart disease or stroke occurred in the antioxidant groups compared with 36 (5.7%) in the no-antioxidant groups

In their remarks in the “Discussion” section of the article, the authors cautioned that, although they found “no evidence to support the use of either aspirin or antioxidants in the primary prevention of cardiovascular events and mortality in people with diabetes,” aspirin should “still be given for secondary prevention of cardiovascular disease in people with diabetes mellitus, when the evidence base is convincing, and the results of this study must not detract from this important standard of care.”