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      Benefits and Risks Associated With Aspirin Use in Patients With Diabetes for the Primary Prevention of Cardiovascular Events and Mortality: A Meta-Analysis

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          Abstract

          Purpose

          A meta-analysis was conducted to assess the benefits and risks of aspirin for the primary prevention of cardiovascular disease and all-cause mortality events in adults with diabetes.

          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 Cochrane Collaboration’s risk of bias tool was used to assess the methodological quality of the included studies. Random-effects meta-analysis was used to calculate the pooled odds ratio for outcomes of cardiovascular events, death, and adverse events.

          Findings

          A total of 8 studies were included with 32,024 patients with diabetes; 16,001 allocated to aspirin, and 16,023 allocated to the control group. There was no difference between aspirin and control groups with respect to all-cause mortality, cardiovascular mortality, or bleeding events. However, MACE was significantly lower in the aspirin group.

          Implications

          Although aspirin has no significant risk on primary endpoints of cardiovascular events and bleeding outcomes in patients with diabetes compared to control, major adverse cardiovascular events (MACE) were significantly lower in the aspirin group. Further 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.

          Systematic Review Registration

          identifier [XU#/IRB/2020/1005].

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          Most cited references35

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            The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials

            Julian P. T. Higgins, Douglas G. Altman, Peter C. Gøtzsche … (2013)
            Flaws in the design, conduct, analysis, and reporting of randomised trials can cause the effect of an intervention to be underestimated or overestimated. The Cochrane Collaboration’s tool for assessing risk of bias aims to make the process clearer and more accurate
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              2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts)Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR).

              Massimo F. Piepoli, Arno Hoes, Stefan Agewall … (2016)
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                Author and article information

                Contributors
                Journal
                Journal ID (nlm-ta): Front Endocrinol (Lausanne)
                Journal ID (iso-abbrev): Front Endocrinol (Lausanne)
                Journal ID (publisher-id): Front. Endocrinol.
                Title: Frontiers in Endocrinology
                Publisher: Frontiers Media S.A.
                ISSN (Electronic): 1664-2392
                Publication date (Electronic): 01 September 2021
                Publication date Collection: 2021
                Volume: 12
                Electronic Location Identifier: 741374
                Affiliations
                [1] 1Deparment of Vasculocardiology, Xianyang Central Hospital , Xianyang, China
                [2] 2Deparment of Vasculocardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences , Beijing, China
                [3] 3Department of Hematology, Xianyang Central Hospital , Xianyang, China
                [4] 4Department of General Surgery, The Second People’s Hospital , Kunshan, Suzhou, China
                Author notes

                Edited by: Bhagat Singh, University of Delhi, India

                Reviewed by: Rohit Bhardwaj, University of Delhi, India; Sinhayana Choudhury, All India Institute of Medical Sciences Bhubaneswar, India

                This article was submitted to Clinical Diabetes, a section of the journal Frontiers in Endocrinology

                †These authors share first authorship

                Article
                DOI: 10.3389/fendo.2021.741374
                PMC ID: 8440957
                SO-VID: 85555385-d17e-4df3-a535-5b070b7fe14e
                Copyright © Copyright © 2021 Ma, Gu, Niu, Li and Wang
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                Date received : 14 July 2021
                Date accepted : 16 August 2021
                Page count
                Figures: 5, Tables: 2, Equations: 0, References: 36, Pages: 8, Words: 3500
                Categories
                Subject: Endocrinology
                Subject: Systematic Review

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: aspirin,diabetes,cardiovascular diseases,mortality rate,mace
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: aspirin, diabetes, cardiovascular diseases, mortality rate, mace

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