Large trial on low-dose aspirin in diabetics
HIV is so deadly largely because it evolves so rapidly. With a single virus as the origin of an infection, most patients will quickly come to harbor thousands of different versions of HIV, all a little bit different and all competing with one another to most efficiently infect that person’s cells. Its rapid and unique
Full Post: Scientists show that HIV’s evolution in the body does not occur at a constant rate
Type 2 diabetics treated with low-dose aspirin did not have a significantly lower incidence of atherosclerotic events than those who received placebo in this primary prevention trial of low-dose aspirin, according to research presented at the American Heart Association’s Scientific Sessions 2008. However, sub-group analyses showed a significant reduction with aspirin in both atherosclerotic events in those over 65 years of age, and a reduction in cerebrocardiovascular deaths.
Results from The Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial were presented as a late-breaking clinical trial. The study was simultaneously published in the Journal of the American Medical Association.
“Our results indicate that aspirin is effective and safe for primary prevention of cardiac and cerebrocardiovascular death in diabetics,” said Hisao Ogawa, M.D, Ph.D., lead investigator of the study and a professor of cardiovascular medicine at Kumamoto University, Kumamoto, Japan, and chief of the division of cardiology at the Kumamoto University Hospital. “In addition, it offers a low-cost approach.”
The randomized trial included 2,539 type 2 diabetics at 163 Japanese medical centers.
Researchers observed a positive trend for a reduction in all atherosclerotic events in the aspirin group (20 percent relative risk reduction) for the entire population, but it did not reach statistical significance. Atherosclerotic events include coronary heart disease death, fatal stroke, non-fatal myocardial infarction, unstable angina, exertional angina, non-fatal stroke including transient ischemic attack, and peripheral arterial disease.
In a subgroup analysis, the researchers found an association between daily low-dose aspirin use and a 32 percent reduced relative risk for all atherosclerotic events, both fatal and non-fatal, but only for diabetics over age 65. In other words, individuals over age 65 who took aspirin had a hazard ratio of 0.68 compared to those who did not take aspirin.
During an average of 4.4 years of follow-up, 154 atherosclerotic events occurred, both fatal and non-fatal (68 in the aspirin group, 86 in the non-aspirin group.) Those events included one fatal cardiovascular event (a hemorrhagic stroke) in the aspirin group and 10 fatal strokes or heart attacks in the non-aspirin group, Ogawa said.
Researchers found a large, statistically significant risk reduction for fatal coronary and cerebrovascular events in the aspirin group vs. the non-aspirin group (hazard ratio of 0.10.) But the confidence interval on that finding was wide (CI=0.01 to 0.8), indicating a need for further study, he said.
Diabetes is considered one of the strongest risk factors for cardiovascular events. Aspirin therapy is commonly used for primary prevention in diabetic patients in the United States and Canada, but not in Japan, Ogawa said.
Several earlier studies have established the benefits of aspirin therapy in preventing second cardiac events. However, its use for primary prevention in diabetics, i.e., prevention in patients without a history of cardiovascular disease, has been controversial because of the lack of data indicating benefits and because aspirin carries a risk of gastric bleeding, Ogawa said.
He said aspirin was well tolerated as demonstrated by the comparable number of the combined endpoint of serious hemorrhagic events (hemorrhagic strokes and major gastrointestinal bleeds).
In comparing bleeding events, the researchers reported 13 hemorrhagic strokes, with no statistically significant difference between aspirin takers and non-takers (six such strokes in the aspirin group; seven in the non-aspirin group).
On the other hand, the total number of all hemorrhagic events was greater in the aspirin group compared to the non-aspirin group (34 vs. 10 such events). Four patients in the aspirin group had bleeding events that required transfusion. Furthermore, those in the aspirin group had more gastrointestinal symptoms (55 cases vs. eight cases), but all cases were resolved without surgery and no fatalities occurred, he said.
“Our findings need to be interpreted in the context of the low incidence of atherosclerotic disease in Japan,” Ogawa said. “We conclude that aspirin as primary prevention is beneficial at least for fatal heart attack and fatal stroke in our entire study group and for all atherosclerotic disease among those age 65 or over.”
Co-authors are: Masafumi Nakayama, M.D., Ph.D.; Takeshi Morimoto, M.D., Ph.D.; Shiro Uemura, M.D., Ph.D.; Masao Kanauchi, M.D., Ph.D.; Naofumi Doi, M.D., Ph.D.; Seigo Sugiyama, M.D., Ph.D.; and Yoshihiko Saito, M.D., Ph.D. Individual author disclosures are available on the abstract.
The study was funded by Japan’s Ministry of Health, Labour and Welfare.
Low-dose aspirin as primary prevention did not appear to significantly reduce the risk of a combined end point of coronary, cerebrovascular and peripheral vascular events in patients with type 2 diabetes, according to a new study in Journal of the American Medical Association. However, aspirin did significantly reduce the combination of fatal coronary and fatal
Full Post: Low-dose aspirin does not appear to reduce risk of CV events in patients with diabetes
Aspirin, recommended as a preventive approach for patients at risk of hereditary colorectal cancer, does not provide protection against Lynch syndrome, the most common form of hereditary colorectal cancer, according a study published in the Dec. 11 issue of the New England Journal of Medicine. Henry Lynch, M.D., professor of medicine and director Creighton University
Full Post: Aspirin does not provide protection against Lynch syndrome
Researchers reported on a study of a new oral anti-clotting agent - rivaroxaban - designed to identify doses that would be safe to test in subsequent Phase III efficacy and safety trials. The results of ATLAS ACS-TIMI 46 were presented as a late-breaking clinical trial at the American Heart Association’s Scientific Sessions 2008. “The
Full Post: Rivaroxaban shows promise in patients with acute coronary syndrome
Screening with an ultrasound machine has proved highly successful in preventing stroke among children with sickle cell disease, by identifying children who are then preventively treated with blood transfusions. Over an eight-year period at The Children’s Hospital of Philadelphia, researchers found that the technique, transcranial Doppler ultrasonography (TCD), along with regular transfusions for children found
Full Post: Ultrasound helps prevent stroke in children with sickle cell disease
Neither vitamin E nor vitamin C supplements reduced the risk of major cardiovascular events in a large, long-term study of male physicians, according to a study in the November 12 issue of Journal of the American Medical Association. The article is being released early online November 9 to coincide with the scientific presentation of the
Full Post: Vitamins C and E do not prevent cardiovascular disease in men