Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
Circ J. 2012;76(6):1526-32. doi: 10.1253/circj.cj-11-1033. Epub 2012 Mar 23.
There are few data that demonstrate a significant effect of aspirin therapy for diabetic patients. To clarify the effect of the primary prevention of aspirin therapy in diabetic patients, the relationship between blood pressure (BP) and the incidence of atherosclerotic events was investigated in participants in the Japanese primary prevention of atherosclerosis with aspirin for diabetes (JPAD) trial.
We divided the JPAD participants according to their systolic (SBP) and diastolic (DBP) BPs at enrollment (SBP ≥140 mmHg and/or DBP ≥90 mmHg: unattained group, SBP <140 mmHg and DBP <90 mmHg: attained group). The incidence of the primary atherosclerotic events, especially cerebrovascular events, was higher in the unattained group than in the attained group. The incidence of cerebrovascular events was higher in the unattained group than in the attained group in patients without aspirin therapy; however, the incidence of cerebrovascular events in the unattained group was as low as the incidence in the attained group in patients undergoing aspirin therapy. Cox proportional hazards analysis revealed that BP level was an independent predictor for cerebrovascular events in diabetic patients.
Aspirin therapy may reduce cerebrovascular events in diabetic patients with higher BP. Aspirin therapy could be an additional strategy as primary prevention for diabetic patients with higher BP.
目前鲜有数据表明阿司匹林治疗对糖尿病患者有显著效果。为了阐明阿司匹林治疗对糖尿病患者一级预防的作用，我们对日本糖尿病阿司匹林一级预防动脉硬化研究（JPAD）试验的参与者进行了研究，以调查血压（BP）与动脉粥样硬化事件发生率之间的关系。
我们根据 JPAD 参与者入组时的收缩压（SBP）和舒张压（DBP）（SBP≥140mmHg 和/或 DBP≥90mmHg：未达标组，SBP<140mmHg 和 DBP<90mmHg：达标组）对其进行了分组。未达标组的主要动脉粥样硬化事件（尤其是脑血管事件）发生率高于达标组。在未接受阿司匹林治疗的患者中，未达标组的脑血管事件发生率高于达标组；然而，在接受阿司匹林治疗的患者中，未达标组的脑血管事件发生率与达标组相当。Cox 比例风险分析显示，BP 水平是糖尿病患者脑血管事件的独立预测因子。
阿司匹林治疗可能降低血压较高的糖尿病患者的脑血管事件风险。对于血压较高的糖尿病患者，阿司匹林治疗可能是一种额外的一级预防策略。
