Purpose of Review

To review the clinical evidence of the effect of aspirin as primary prevention for patients with diabetes mellitus and in healthy elderly.

Recent Findings

Two trials were performed to study these two patient populations: ASCEND showed that the use of low-dose aspirin in persons with diabetes, who did not have prior cardiovascular disease, led to a lower risk of cardiovascular events than placebo (8.5% vs 9.6%, rate ratio 0.88, 95% CI 0.79–0.97; p = 0.01). However, it showed a similar magnitude of increased risk of major bleeding among the aspirin group compared with placebo (4.1% vs 3.2%, rate ratio 1.29, 95% CI 1.09–1.52; p = 0.003). ASPREE showed that the use of low-dose aspirin in healthy elderly did not prolong disability-free survival (21.5% vs 21.2%, HR 1.01, 95% CI 0.92–1.11; p = 0.79); however, the rate of major hemorrhage was higher in the aspirin group than in the placebo group (3.8% vs 2.8%, HR 1.38, 95% CI 1.18–1.62; p < 0.001). Additionally, further analyses of secondary end points of death, cardiovascular disease, and major hemorrhage were also studied. Higher all-cause mortality was seen among healthy elderly who received aspirin compared with placebo (12.7% vs 11.1%, HR 1.14, 95% CI 1.01–1.29) and was primarily attributed to cancer-related deaths. Similar risk of cardiovascular disease was seen among elderly who received aspirin compared with placebo (10.7% vs 11.3%, HR 0.95, 95% CI 0.83–1.08) and resulted in a significantly higher risk of major hemorrhage (8.6% vs 6.8%, HR 1.38, 95% CI 1.18–1.62; p < 0.001).

Summary

These studies show that the use of low-dose aspirin as primary prevention in patients with diabetes and in the elderly does not have overall beneficial effect compared with its use in secondary prevention. In patients with diabetes without prior cardiovascular disease, the benefits of aspirin use were counterbalanced by the bleeding risk. Additionally, in healthy elderly, the use of aspirin did not prolong disability-free survival and instead led to a higher rate of major hemorrhage.

中文翻译：

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阿司匹林在糖尿病患者和老年人一级预防中的作用。

审查目的

回顾阿司匹林作为糖尿病和健康老人的一级预防作用的临床证据。

最近的发现

进行了两项试验来研究这两个患者人群：ASCEND表明，在未曾患有心血管疾病的糖尿病患者中使用小剂量阿司匹林可导致心血管事件的风险低于安慰剂（8.5％比9.6％） ，比率为0.88，95％CI为0.79-0.97；p  = 0.01）。然而，与安慰剂相比，阿司匹林组的大出血风险增加幅度相似（4.1％vs 3.2％，比率1.29，95％CI 1.09-1.52；p  = 0.003）。ASPREE表明，在健康的老年人中使用小剂量阿司匹林不能延长无残疾生存期（21.5％vs 21.2％，HR 1.01，95％CI 0.92-1.11；p = 0.79）; 然而，阿司匹林组的重大出血发生率高于安慰剂组（3.8％vs 2.8％，HR 1.38，95％CI 1.18-1.62；p  <0.001）。此外，还对死亡，心血管疾病和主要出血的次要终点进行了进一步分析。与安慰剂相比，接受阿司匹林的健康老年人的全因死亡率更高（分别为12.7％和11.1％，HR 1.14、95％CI 1.01-1.29），这主要归因于与癌症相关的死亡。与安慰剂相比，接受阿司匹林的老年人患心血管疾病的风险相似（10.7％vs 11.3％，HR 0.95，95％CI 0.83–1.08），导致重大出血的风险显着更高（8.6％vs 6.8％，HR 1.38，95％CI 1.18–1.62；p  <0.001）。

概要

这些研究表明，与在二级预防中使用低剂量的阿司匹林作为糖尿病患者和老年人的一级预防剂相比，其没有整体的有益效果。在没有心血管疾病的糖尿病患者中，使用阿司匹林的益处被出血风险所抵消。此外，在健康的老年人中，使用阿司匹林不能延长无残疾生存期，而是导致更高的严重出血率。