D.Caldeira1,2,3· M. Alves3,4,5 · J. J. Ferreira3,4 · F. J. Pinto1,2

Received: 5 October 2022 / Accepted: 29 December 2022 / Published online: 18 January 2023 © The Author(s) 2023

D. Caldeira

该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Centro Cardiovascular da Universidade de Lisboa–CCUL (CCUL@RISE), Faculdade de Medicina, CEMBE, CAML, Universidade de Lisboa, Lisbon, Portugal

2 Serviço de Cardiologia, Hospital Universitário de Santa Maria–CHULN, Lisbon, Portugal

3 Laboratory of Clinical Pharmacology and Therapeutics, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal

4 Faculdade de Medicina, Instituto de Medicina Molecular, Universidade de Lisboa, Lisbon, Portugal

5 Serviço de Medicina III, Hospital Pulido Valente, CHLN, Lisbon, Portugal

Abstract

Purpose Aspirin use among patients with diabetes in primary prevention is still a matter of debate. We aimed to evaluate the potential cardiovascular risk benefit of aspirin in primary prevention, using data from a contemporary cohort.

Methods Retrospective analysis of the VITAL cohort with>20,000 individuals at primary prevention who were followed for a median of 5.3 years. The population was evaluated according to the baseline diabetes status, and then aspirin use was evaluated among diabetic patients. Cox regression models were used to estimate the risks of mortality and cardiovascular outcomes. The estimates were reported using adjusted hazard ratio (HR) and 95% confidence intervals (95%CI).

Results Diabetic patients (n=3549; 13.7%) showed to increase the risk of all-cause mortality (HR 1.61, 95%CI 1.33–1.94), and major adverse cardiovascular events (MACE) (HR 1.36 95%CI 1.11–1.68) than non-diabetic population. Diabetic patients taking aspirin were older, more frequently man, hypertensive, current users of statins, and current smokers compared with diabetic patients who did not use aspirin at baseline. There was no difference between diabetic aspirin users and non-users regarding all-cause mortality (HR 0.80, 95%CI 0.59, 1.10), MACE (HR 0.92, 95%CI 0.64, 1.33), coronary heart disease (HR 0.98, 95%CI 0.67, 1.43), or stroke (HR 0.87, 95%CI 0.48, 1.58).

Conclusions The VITAL data confirmed diabetes as an important risk factor for cardiovascular events in a contemporary cohort but did not show cardiovascular benefits of aspirin in primary prevention among people with diabetes who were shown to be at higher risk of cardiovascular events.

Keywords Cardiovascular disease · Primary prevention · Aspirin · Diabetes

AUTHORS

Pam Chen1,2, Nalini Campillo Vilorio3 , Ketan Dhatariya4, 5, William Jeffcoate6 , Ralf Lobmann7 , Caroline McIntosh8 , Alberto Piaggesi9 , John Steinberg10, Prash Vas11, Vijay Viswanathan12, Stephanie Wu13, Fran Game14, on behalf of the International Working Group on the Diabetic Foot

INSTITUTIONS

1 Joondalup Health Campus, Ramsay Healthcare Australia, Joondalup, Western Australia, Australia

2 Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia

3 Department of Diabetology, Diabetic Foot Unit, Plaza de la Salud General Hospital, Santo Domingo, Dominican Republic

4 Elsie Bertram Diabetes Centre, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK

5 Norwich Medical School, University of East Anglia, Norwich, UK

6 Retired physician, Nottingham, UK

7 Clinic for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart, Stuttgart, Germany

8 Podiatric Medicine, School of Health Sciences, University of Galway, Ireland

9 Diabetic Foot Section, Department of Medicine, University of Pisa, Italy

10 Georgetown University School of Medicine, Washington DC, USA

11 King’s College Hospital NHS Foundation Trust, London, UK

12 MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Center, Chennai, India

13 Dr. William M. Scholl College of Podiatric Medicine at Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA

14 University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK