Aspirin Benefit Blunted in People With Diabetes

An aspirin a day has long been a low-cost preventive therapy to reduce cardiovascular events.

But the Primary Prevention Project (PPP), a randomized trial of nearly 5,000 subjects in Italy-including 1,031 with diabetes-concluded that people with diabetes benefit less than other people with cardiovascular risk factors.

Among people with diabetes, low-dose aspirin (100 mg/day) treatment yielded an insignificant increase in cardiovascular deaths, but it also produced an insignificant reduction in the composite endpoint (total cardiovascular deaths, strokes or heart attacks) and total cardiovascular events.

The results for nondiabetics were more favorable.

The trial was stopped after three and a half years because a consistent benefit overall was found for aspirin therapy compared with the control group. Investigators theorize the anti-platelet effects of aspirin are overwhelmed by aspirin-insensitive mechanisms of platelet activation and thrombus formation common in diabetics.

The researchers note that further large-scale trials addressing the role of aspirin in the primary prevention of cardiovascular disease in people with diabetes are urgently needed.

The PPP study also investigated the role of vitamin E (300 mg/day) in preventing cardiovascular events in people with cardiovascular risk factors. No significant benefit was found with vitamin E in either diabetic or non-diabetic study participants.

-Diabetes Care, December 2003

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