Role of Aspirin for primary prevention of cardiovascular and all-cause
mortality events in diabetes: An updated meta-analysis of randomized
controlled trials.
Abstract
Background: The use of Aspirin in the primary prevention of
cardiovascular disease (CVD) is still a topic of debate, especially in
patients with diabetes. The present meta-analysis aims to rule out the
efficacy of Aspirin in patients with diabetes and to compare the
effectiveness of Aspirin with a placebo (or no treatment) for the
primary prevention of CVD and all-cause mortality events in people with
diabetes. Materials and Methods: An extensive and systematic search was
conducted in Medline (via PubMed), Cinahl (via Ebsco), Scopus, and Web
of Sciences from 1988 to December 2020. A detailed literature search was
conducted using Aspirin, cardiovascular disease (CVD), diabetes, and
efficacy to identify trials of patients with diabetes who received
Aspirin for primary prevention of CVD. Demographic details with the
primary outcome of events and bleeding outcomes were analyzed. The risk
of bias (RoB) in included studies was evaluated using the QUADAS-2 tool.
Results: A total of 5 studies out of 13 were included with 23,570
diabetic patients; 11,738 allocated to Aspirin and 11,832 allocated to
the placebo group. In patients with diabetes, there was no difference
between Aspirin and placebo with respect to the risk of all-cause death
with a confidence interval (CI) varying 0.63 to 1.17. In addition, there
were no differences in the bleeding outcomes with an odds ratio of
1.4411 (CI 0.47 to 4.34). Conclusion: Aspirin has no significant risk on
primary endpoints of cardiovascular events and the bleeding outcomes in
diabetic patients compared to placebo. More research on the use of
Aspirin alone or in combination with other antiplatelet drugs is
required in patients with diabetes to supplement currently available
research.