Kunutsor S K, Seidu S, Khunti K
School of Clinical Sciences, University of Bristol, Southmead Hospital, Southmead, UK.
Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.
Diabet Med. 2017 Mar;34(3):316-327. doi: 10.1111/dme.13133. Epub 2016 May 22.
To evaluate the benefits and harms of aspirin for the primary prevention of cardiovascular disease and all-cause mortality events in people with diabetes by conducting a systematic review and meta-analysis.
Randomized controlled trials of aspirin compared with placebo (or no treatment) in people with diabetes with no history of cardiovascular disease were identified from MEDLINE, EMBASE, Web of Science, the Cochrane Library and a manual search of bibliographies to November 2015. Study-specific relative risks with 95% CIs were aggregated using random effects models.
A total of 10 randomized trials were included in the review. There was a significant reduction in risk of major adverse cardiovascular events: relative risk of 0.90 (95% CI 0.81-0.99) in groups taking aspirin compared with placebo or no treatment. Limited subgroup analyses suggested that the effect of aspirin on major adverse cardiovascular events differed by baseline cardiovascular disease risk, medication compliance and sex (P for interaction for all > 0.05).There was no significant reduction in the risk of myocardial infarction, coronary heart disease, stroke, cardiovascular mortality or all-cause mortality. Aspirin significantly reduced the risk of myocardial infarction for a treatment duration of ≤ 5 years. There were differences in the effect of aspirin by dosage and treatment duration on overall stroke outcomes (P for interaction for all < 0.05). There was an increase in risk of major or gastrointestinal bleeding events, but estimates were imprecise and not significant.
The emerging data do not clearly support guidelines that encourage the use of aspirin for the primary prevention of cardiovascular disease in adults with diabetes who are at increased cardiovascular disease risk.
通过进行系统评价和荟萃分析，评估阿司匹林在糖尿病患者中对心血管疾病一级预防及全因死亡事件的利弊。
从MEDLINE、EMBASE、科学引文索引、考克兰图书馆以及截至2015年11月的文献目录手工检索中，识别出将阿司匹林与安慰剂（或不治疗）进行比较的糖尿病且无心血管疾病史患者的随机对照试验。使用随机效应模型汇总各研究的特定相对风险及95%置信区间。
该评价共纳入10项随机试验。服用阿司匹林组与安慰剂组或不治疗组相比，主要不良心血管事件风险显著降低：相对风险为0.90（95%置信区间0.81 - 0.99）。有限的亚组分析表明，阿司匹林对主要不良心血管事件的影响因基线心血管疾病风险、药物依从性和性别而异（所有交互作用P值>0.05）。心肌梗死、冠心病、中风、心血管死亡率或全因死亡率风险无显著降低。阿司匹林在治疗持续时间≤5年时显著降低心肌梗死风险。阿司匹林的剂量和治疗持续时间对总体中风结局的影响存在差异（所有交互作用P值<0.05）。主要或胃肠道出血事件风险增加，但估计值不精确且无显著性。
新出现的数据并不明确支持鼓励在心血管疾病风险增加的成年糖尿病患者中使用阿司匹林进行心血管疾病一级预防的指南。
