Adding Acetylsalicylic Acid in Primary Prevention in T2D
Cardiovascular diseases are the main cause of death, hospitalization and disability among people with type 2 diabetes mellitus. The incidence of cardiovascular disease in people with diabetes is more than double that in people without diabetes, and the mortality rate after a first myocardial infarction is much higher in people with diabetes.
For this reason, primary prevention of cardiovascular diseases is very important in people with diabetes. At this regard, the Italian trial MIND-IT (The Multiple Intervention in type 2 Diabetes Italy) showed that a multi-factorial intensive intervention in type 2 diabetes is feasible and effective in clinical practice and it is associated with significant and durable improvement in glycated hemoglobin (HbA 1c) and cardiovascular disease risk profile. This was confirmed by the Italian guidelines for the treatment of type 2 diabetes mellitus that recommended primary prevention in patients with diabetes throughout changes in lifestyle, glycemic and lipid control, blood pressure control, and possible introduction of anti-platelet therapy. Also the recently published American Diabetes Association guidelines recommend aspirin therapy (75–162 mg/day) as a primary prevention strategy in patients at increased cardiovascular risk, including men aged >50 years or women aged >60 years with, at least, one additional major risk factor (family history of cardiovascular disease, hypertension, smoking, dyslipidemia, or albuminuria). Despite the higher absolute risk of cardiovascular disease in these patients, however, there is no robust evidence that the use of acetylsalicylic acid (ASA) leads to a favourable benefits-to-risk balance. The JPAD study (Japanese Primary Prevention of Atherosclerosis with aspirin for Diabetes) analyzed the effect of ASA, 81–100 mg, in patients with type 2 diabetes in primary prevention of atherosclerotic events. The risk of cardiovascular disease did not differ between the group receiving ASA and the one that did not, however, among individuals aged 65 years and older, the incidence of atherosclerotic events was significantly lower in the group receiving ASA compared with the group who did not. On the other hand, the POPADAD trial (Prevention of progression of arterial disease and diabetes) trial, conducted in patients with diabetes mellitus and asymptomatic peripheral arterial disease, did not provide evidence to support the use of aspirin in primary prevention of cardiovascular events and mortality in the population with diabetes.
Recently some new emerging biomarkers, including soluble CD40 ligand (sCD40L) and serum myeloperoxidase (MPO), have been linked to a higher cardiovascular risk. On this basis the aim of this study was to evaluate the relevance of adding ASA in primary prevention in subjects with type 2 diabetes mellitus. To verify this, we evaluated ASA effects on the levels of some new emerging biomarkers of higher cardiovascular risk in patients with diabetes and hypertension.
Background
Cardiovascular diseases are the main cause of death, hospitalization and disability among people with type 2 diabetes mellitus. The incidence of cardiovascular disease in people with diabetes is more than double that in people without diabetes, and the mortality rate after a first myocardial infarction is much higher in people with diabetes.
For this reason, primary prevention of cardiovascular diseases is very important in people with diabetes. At this regard, the Italian trial MIND-IT (The Multiple Intervention in type 2 Diabetes Italy) showed that a multi-factorial intensive intervention in type 2 diabetes is feasible and effective in clinical practice and it is associated with significant and durable improvement in glycated hemoglobin (HbA 1c) and cardiovascular disease risk profile. This was confirmed by the Italian guidelines for the treatment of type 2 diabetes mellitus that recommended primary prevention in patients with diabetes throughout changes in lifestyle, glycemic and lipid control, blood pressure control, and possible introduction of anti-platelet therapy. Also the recently published American Diabetes Association guidelines recommend aspirin therapy (75–162 mg/day) as a primary prevention strategy in patients at increased cardiovascular risk, including men aged >50 years or women aged >60 years with, at least, one additional major risk factor (family history of cardiovascular disease, hypertension, smoking, dyslipidemia, or albuminuria). Despite the higher absolute risk of cardiovascular disease in these patients, however, there is no robust evidence that the use of acetylsalicylic acid (ASA) leads to a favourable benefits-to-risk balance. The JPAD study (Japanese Primary Prevention of Atherosclerosis with aspirin for Diabetes) analyzed the effect of ASA, 81–100 mg, in patients with type 2 diabetes in primary prevention of atherosclerotic events. The risk of cardiovascular disease did not differ between the group receiving ASA and the one that did not, however, among individuals aged 65 years and older, the incidence of atherosclerotic events was significantly lower in the group receiving ASA compared with the group who did not. On the other hand, the POPADAD trial (Prevention of progression of arterial disease and diabetes) trial, conducted in patients with diabetes mellitus and asymptomatic peripheral arterial disease, did not provide evidence to support the use of aspirin in primary prevention of cardiovascular events and mortality in the population with diabetes.
Recently some new emerging biomarkers, including soluble CD40 ligand (sCD40L) and serum myeloperoxidase (MPO), have been linked to a higher cardiovascular risk. On this basis the aim of this study was to evaluate the relevance of adding ASA in primary prevention in subjects with type 2 diabetes mellitus. To verify this, we evaluated ASA effects on the levels of some new emerging biomarkers of higher cardiovascular risk in patients with diabetes and hypertension.