Effect of Low-Dose Aspirin on Primary Prevention of Cardiovascular Events in Japanese Diabetic Patients at High Risk
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概要
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Background: Benefit of low-dose aspirin for primary prevention of cardiovascular events in diabetes remains controversial. The American Diabetes Association (ADA), the American Heart Association (AHA), and the American College of Cardiology Foundation (ACCF) recommend aspirin for high-risk diabetic patients: older patients with additional cardiovascular risk factors. We evaluated aspirin's benefit in Japanese diabetic patients stratified by cardiovascular risk. Methods and Results: In the JPAD trial, we enrolled 2,539 Japanese patients with type 2 diabetes and no history of cardiovascular disease. We randomly assigned them to aspirin (81–100mg daily) or no aspirin groups. The median follow-up period was 4.4 years. We stratified the patients into high-risk or low-risk groups, according to the US recommendation: age (older; younger) and coexisting cardiovascular risk factors. The risk factors included smoking, hypertension, dyslipidemia, family history of coronary artery disease, and proteinuria. Most of the patients were classified into the high-risk group, consisting of older patients with risk factors (n=1,804). The incidence of cardiovascular events was higher in this group, but aspirin did not reduce cardiovascular events (hazard ratio [HR], 0.83; 95% confidence interval [CI]: 0.58–1.17). In the low-risk group, consisting of older patients without risk factors and younger patients (n=728), aspirin did not reduce cardiovascular events (HR, 0.55; 95% CI: 0.23–1.21). These results were unchanged after adjusting for potential confounding factors. Conclusions: Low-dose aspirin is not beneficial in Japanese diabetic patients at high risk.
著者
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Sugiyama Seigo
Department Of Cardiovascular Medicine Graduate School Of Medical Science Kumamoto University
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Soeda Tsunenari
First Department Of Internal Medicine Nara Medical University
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Doi Naofumi
First Department Of Internal Medicine Nara Medical University
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Uemura Shiro
First Department Of Internal Medicine Nara Medical University
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Kawata Hiroyuki
First Department Of Internal Medicine Nara Medical University
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Somekawa Satoshi
First Department Of Internal Medicine Nara Medical University
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Horii Manabu
First Department Of Internal Medicine Nara Medical University
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Nakayama Masafumi
Department Of Cardiovascular Medicine Graduate School Of Medical Science Kumamoto University
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Morimoto Takeshi
Division Of Electrical Electric And Information Engineering Graduate School Of Engineering Osaka Uni
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Saito Yoshihiko
First Department Of Internal Medicine Nara Medical University
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Soejima Hirofumi
Department Of Cardiology Kumamoto Chuo Hospital
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Ogawa Hisao
Department Cardiovascular Medicine Kumamoto University:division Of Intensive Care Unit Kumamoto Univ
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OKADA Sadanori
First Department of Internal Medicine, Nara Medical University
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Waki Masako
Division Of Endocrinology And Metabolism Department Of Internal Medicine Shizuoka City Shizuoka Hospital
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Jinnouchi Hideaki
Jinnouchi Clinic Diabetes Care Center
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Doi Naofumi
First Department of Internal Medicine, Nara Medical University
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Soejima Hirofumi
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
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Sakuma Mio
Division of General Internal Medicine, Hyogo College of Medicine
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Nakayama Masafumi
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
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Nakayama Masafumi
Department of Cardiology, Tachikawa General Hospital, Japan
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Sugiyama Seigo
Department of Cardiovascular Medicine, Graduate School of Medical Science, Kumamoto University
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