Aspirin and Other Antiplatelet Agents and Their Effects on Cardiovascular Disease in Type 2 Diabetes

Abstract

Reduction of cardiovascular disease (CVD) events in patients with type 2 diabetes remains an area of intense interest and research. Recent trials of lower systolic blood pressure goals and combination lipid therapy have failed to show a significant reduction in CVD events in patients with diabetes. Antiplatelet agents are an additional option for CVD risk reduction in patients both with and without diabetes. However, two recent trials have questioned the role of aspirin in the primary prevention of CVD events in patients with diabetes. Although sub-analyses of larger trials have suggested a potential benefit of thienopyridine therapy in patients with diabetes, direct comparative trials are lacking and aspirin remains the appropriate first-line agent. Recent guidelines issued by the American Diabetes Association, American Heart Association, and American College of Cardiology Foundation on the use of aspirin for primary prevention in patients with diabetes remain the standard of practice. Two ongoing trials will help to address the question of the relative benefit of aspirin in patients with diabetes. The Aspirin and Simvastatin Combination for Cardiovascular Events Prevention Trial in Diabetes (ACCEPT-D) and A Study of Cardiovascular Events in Diabetes (ASCEND) are both randomized trials of 100 mg of aspirin compared to placebo and will enroll a combined 15,000 patients with diabetes between the two trials. Results may become available as soon as 2012.