Primary Prevention Of Myocardial Infarction Research Articles

Myocardial infarction in young patients. Is everything so obvious?

The review is devoted to the analysis of literature data on the features of the course, diagnosis and treatment of myocardial infarction at a young age. Despite the relevance of the problem of myocardial infarction in young people, there is no specific approach to the management and examination of such patients in current clinical guidelines. Literature search was carried out in the following databases: PubMed, Google Scholar, Web of Science from 1990 to 2023 for all studies with the keywords “myocardial infarction and young age”, “atherosclerosis and young age”, “atherothrombosis and young age”. An analysis of all available clinical recommendations of leading specialized societies in the field of cardiology, hematology, and angiology was also carried out. The presented review is not systematic view of the specifics of the subject, its breadth, as well as the task set – to expand the clinical thinking of the doctor. It is undeniable that primary prevention of myocardial infarction is more effective. Given the annual increase in the number of myocardial infarctions at a young age, it is necessary to create a special tool for risk stratification in young patients, since there is no such tool in the clinical guidelines. Despite the greater contribution of non-atherogenic causes to the development of myocardial infarction in young patients, atherosclerosis is still the main cause of its development. The authors of the review confirm the fact that there is currently no specially developed algorithm for managing patients with myocardial infarction at a young age, based on the identification of a number of traditional and non-traditional risk factors, on enhanced rehabilitation measures. All these positions are currently formulated in the aims and objectives of a special sevenyear study of myocardial infarction in young patients planned at our institute.

An international perspective on low-dose aspirin for the primary prevention of myocardial infarction

An international perspective on low-dose aspirin for the primary prevention of myocardial infarction

Polygenic Risk Score and Statin Relative Risk Reduction for Primary Prevention of Myocardial Infarction in a Real-World Population.

Genetic substudies of randomized controlled trials demonstrate that high coronary heart disease (CHD) polygenic risk score modifies statin CHD relative risk reduction; it is unknown if the association extends to statin users undergoing routine care. We sought to determine how statin effectiveness is modified by CHD polygenic risk score in a real-world cohort of participants without previous myocardial infarction. We determined CHD polygenic risk scores in participants of the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort. Covariate-adjusted Cox regression models were used to compare the risk of cardiovascular outcomes between statin users and matched nonusers. Statin effectiveness on incident myocardial infarction showed no gradient with increasing 10-year Pooled Cohort Equations atherosclerotic cardiovascular disease (ASCVD) risk across low, borderline, intermediate, and high ASCVD risk score groups. In contrast, statin effectiveness by polygenic risk was largest in the high polygenic risk score group (hazard ratio (HR) 0.41, 95% confidence interval (CI), 0.31-0.53; P=1.5E-11), intermediate in the intermediate polygenic risk score group (HR 0.56, 95% CI, 0.47-0.66; P=8.4E-12), and smallest in the low polygenic risk score group (HR 0.67, 95% CI, 0.47-0.97; P=0.03; P for high vs. low=0.01). ASCVD risk and statin low-density lipoprotein cholesterol (LDL-C) lowering did not differ across polygenic risk score groups. In patients undergoing routine care, CHD polygenic risk modified statin relative risk reduction of incident myocardial infarction independent of LDL-C lowering. Our findings extend prior work by identifying a subset (i.e., self-identified White individuals with low CHD polygenic risk scores) with attenuated clinical benefit from statins.

Primary prevention of myocardial infarction: aspirin is not as useful as it seems.

BackgroundAspirin has not been reliably shown to reduce all-cause and cardiovascular mortality but can prevent symptomatic myocardial infarction. However, silent myocardial infarction (SMI) is not uncommon in clinical practice. No meta-analysis has compared the effect of aspirin administration on primary prevention of all myocardial infarctions, including SMI.MethodsWe systematically searched PubMed, Embase, Web of Science, Cochrane Library and Google Scholar for randomized double-blind controlled trials evaluating the effect of aspirin on primary prevention of all myocardial infarctions, including SMI.ResultsThe current meta-analysis included 9 trials involving 67,486 patients and 67,557 controls on aspirin primary prevention of all myocardial infarctions. When SMI was included in the total number of myocardial infarctions, the aspirin effect on the primary prevention of myocardial infarction was not as significant as expected [risk ratio (RR): 0.883; 95% confidence interval (CI): 0.780 to 1.001; P=0.052].ConclusionsAspirin may not provide a primary preventive effect in all myocardial infarction patients. Previously demonstrated reductions in myocardial infarction are not present when SMI is included.

Prospects for the Primary Prevention of Myocardial Infarction and Stroke.

Cardiovascular disease (CVD), principally myocardial infarction (MI) and stroke, is the leading clinical and public health problem in the United States and is rapidly becoming so worldwide. Their primary prevention is promising, in theory, but difficult to achieve in practice. The principal modalities that have demonstrated efficacy include therapeutic lifestyle changes (TLCs) and adjunctive drug therapies under the guidance of the health-care provider and tailored to the individual patient. The prevention and treatment of the pandemic of overweight and obesity and lack of regular physical activity, both of which are alarmingly common in the United States, prevention and treatment of hypertension, avoidance and cessation of cigarette smoking, adoption and maintenance of a healthy diet, and avoidance of heavy alcohol consumption all have proven benefits in decreasing the risks of a first MI and stroke as well as other clinical manifestations of CVD. Although adoption of TLCs would avoid the need for adjunctive drug therapies in many primary prevention subjects, this strategy is difficult to achieve or maintain for most and may be insufficient for many, especially those at high risk with metabolic syndrome. The criteria for metabolic syndrome, affecting over 40% of the adult population older than 40 in the United States, include overweight or obesity, dyslipidemia, hypertension, and insulin resistance, a precursor of diabetes. The adjunctive therapies of proven benefit in the primary prevention of MI and stroke include statins, blood pressure medications, aspirin, and drugs to treat insulin resistance and hyperglycemia. Fortunately, even for patients who prefer prescription of pills to proscription of harmful lifestyles, these drug therapies still have net benefits. The adoption and maintenance of TLCs and adjunctive drug therapies into clinical practice will reduce both the incidence of and mortality from a first MI and stroke as well as other major clinical manifestations of CVD.

Short-term effects of ambient air pollutants and myocardial infarction in Changzhou, China.

Ambient air pollution had been shown strongly associated with cardiovascular diseases. However, the association between air pollution and myocardial infarction (MI) is inconsistent. In the present study, we conducted a time-series study to investigate the association between air pollution and MI. Daily air pollutants, weather data, and MI data were collected from January 2015 to December 2016 in Changzhou, China. Generalized linear model (GLM) was used to assess the immediate effects of air pollutants (PM2.5, PM10, NO2, SO2, and O3) on MI. We identified a total of 5545 cases for MI, and a 10-μg/m3 increment in concentrations of PM2.5 and PM10 was associated with respective increases of 1.636% (95% confidence interval [CI] 0.537-2.740%) and 0.805% (95% CI 0.037-1.574%) for daily MI with 2-day cumulative effects. The associations were more robust among males and in the warm season versus the cold one. No significant effect was found in SO2, NO2, or O3. This study suggested that short-term exposure to PM2.5 and PM10 was associated with the increased MI risks. Our results might be useful for the primary prevention of MI exacerbated by air pollutants.

Primary prevention of myocardial infarction with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers in hypertensive patients with rheumatoid arthritis-A nationwide cohort study.

BackgroundRheumatoid arthritis (RA) is regarded as a high risk factor for myocardial infarction. Hypertension is a major modifiable risk factor contributing to increased risk of myocardial infarction (MI). Dual blood pressure (BP)-lowering and anti-inflammatory effect of renin-angiotensin-system (RAS) inhibitors may possess protective effect from MI in RA population. However, treatment of hypertension with RAS inhibitors and MI in RA population remains unclear.MethodsWe investigated whether RAS blockade could decrease risk of incident MI in hypertensive patients with RA. We identified patients with RA and hypertension from the Registry for Catastrophic Illness, a nation-wide database encompassing almost all of the RA patients in Taiwan from 1995 to 2008. The primary endpoint was MI and the median duration of follow up was 2,986 days. Propensity score weighting and Cox proportional hazards regression models were used to estimate hazard ratios for MI.ResultsAmong 27,335 subjects, 9.9% received angiotensin-converting enzyme inhibitors (ACEIs), 25.9% received angiotensin II receptor blockers (ARBs) and 20.0% received ACEIs or ARBs alternatively. The incidence of MI significantly decreased in patients treated with ACEIs (hazard ratio 0.707; 95% confidence interval 0.595–0.840), ARBs (0.641; 0.550–0.747) and ACEIs/ARBs (0.631; 0.539–0.739). The protective effect of ACEI or ARB therapy was significantly better in patients taking longer duration. The effect remained robust in subgroup analyses.ConclusionsTherapy of ACEIs or ARBs is associated with a lower risk of MI among patients with RA. Hence, hypertension in patients with RA could comprise a compelling indication for RAS inhibitors.

Primary Prevention of Myocardial Infarction in Rheumatoid Arthritis Using Aspirin: A Case-crossover Study and a Propensity Score-matched Cohort Study.

Subjects with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular disease, which is their leading cause of death. Conflicting evidence exists regarding the efficacy of aspirin (ASA) as primary prevention. We evaluated whether a protective association exists between ASA and myocardial infarction (MI) in RA subjects. In the United Kingdom, persons age ≥ 60 years receive free ASA by prescription and 75% of use is by prescription. Subjects ≥ 60 years with RA in the population-based The Health Improvement Network database constituted our study population. We excluded patients with history of MI, angina, stroke, peripheral vascular disease, or coronary artery procedures. Our main outcome was the occurrence of fatal and nonfatal MI. We performed a case-crossover study with each subject contributing a hazard period and a control period 90 days prior to the MI. In addition, to minimize confounding by indication, a propensity score (PS)-matched cohort study was performed, considering all patients with RA with an incident prescription of low-dose ASA as our exposed group. We did not find a protective effect in the case-crossover study (OR 1.83, 95% CI 0.71-4.71), with 55 subjects exposed in the hazard period and 44 in the control period. Similarly, among 1836 subjects included in the PS-matched cohort study (918 ASA users and 918 ASA non-users), we did not find a protective effect of low ASA on MI (HR 1.39, 95% CI 0.87-2.23). We did not find a protective effect of ASA on MI in patients with RA when used as primary prophylaxis.

Cost-effectiveness evaluation of aspirin in primary prevention of myocardial infarction amongst males with average cardiovascular risk in Iran.

Aspirin is one of the certified medicines commonly used for the secondary prevention of myocardial infarction (MI). Aspirin side effects and gastrointestinal bleeding, in particular, have arisen debates on its use for the primary prevention of MI. The present research evaluates the cost-effectiveness of the use of aspirin in the primary prevention of MI among Iranian men with average cardiovascular disease (CVD) risk, using Markov modeling technique. The incremental cost-effectiveness ratios (ICERs) estimated to be 864 USA dollars (USD) per quality-adjusted life years (QALY) gained and 782 USD per life years gained (LYG) for each patient in the base-case scenario (public tariffs and no discounting). This research proves cost-effectiveness of the use of aspirin in the primary prevention of MI in targeted population, since the assessed ICERs are quite under the recommended threshold by WHO which is one gross domestic product (GDP) per capita ($5315.1 for Iran in 2015).

Aspirin for Primary Prevention of Myocardial Infarction: An Evidence Based Clinical Inquiry

Evidence is evaluated to determine whether low dose aspirin (81mg) for primary prevention in patients aged 50-65 with no history of cardiovascular disease decreases the incidence of myocardial infarction. Ten studiesgiving relevant clinical evidence are identified and evaluated, with each gender looked at in isolation.The preliminary evidence of this paper suggests that aspirin for the primary prevention of myocardial infarction is not suitable for women aged 50-65, while it does hold benefits for males of the same age range (Howard, 2014). However, the evidence is not unanimous, and more research is needed before recommending aspirin for primary prevention in all low-risk individuals. In relation to aspirin for primary prevention of myocardial infarction,short- and long-term recommendations for nursing practice are developed and discussed, demonstrating the significant role the nurse plays in education, helping each patient to assess individual risks and benefits, and advising patients to consult their physician before self-medicating (Howard, 2014).

Cost-benefit analysis of the polypill in the primary prevention of myocardial infarction and stroke.

The primary prevention of cardiovascular disease is a public health priority. To assess the costs and benefits of a Polypill Prevention Programme using a daily 4-component polypill from age 50 in the UK, we determined the life years gained without a first myocardial infarction (MI) or stroke, together with the total service cost (or saving) and the net cost (or saving) per year of life gained without a first MI or stroke. This was estimated on the basis of a 50 % uptake and a previously published 83 % treatment adherence. The total years of life gained without a first MI or stroke in a mature programme is 990,000 each year in the UK. If the cost of the Polypill Prevention Programme were £1 per person per day, the total cost would be £4.76 bn and, given the savings (at 2014 prices) of £2.65 bn arising from the disease prevented, there would be a net cost of £2.11 bn representing a net cost per year of life gained without a first MI or stroke of £2120. The results are robust to sensitivity analyses. A national Polypill Prevention Programme would have a substantial effect in preventing MIs and strokes and be cost-effective.

CLINICO-ECONOMICAL EVALUATION OF PRIMARY PREVENTION OF MYOCARDIAL INFARCTION AS ARGUMENTS TO SUPPORT AND RAISING OF EFFICIENCY

The goal of this research was to value of primary prevention of myocardial infarction using clinico-economical indices and to find a way of raising efficiency of its. The costs of treatment 17 378 patients up to 70 years old with stenocardia and expense amount of treatment in out-patient, inpatient departments and ambulance were estimated on the basis of compulsory medical insurance rates. Probability of myocardial infarction in patients with stenocardia was evaluated in relation to medical aid appealability to medical organizations. It was found 31% patients with stenocardia do not seek medical advice in out-patients. Meanwhile probability of myocardial infarction in those patients in 2.3 times higher than in patients received treatment in out-patients. It was found also that 1.0 ruble investment to prophylactic medical examination for patients with stenocardia gives profit 8.5 rubles in view of saved person-years and reducing of treatment expense. That profit can be raised twice by the using of “recipientoriented” primary prevention of myocardial infarction. “Recipient-oriented” primary prevention of myocardial infarction is realized in cooperation of medical organizations, health insurance companies and compulsory medical insurance fund.

Cost-effectiveness and cost-utility analysis of OTC use of simvastatin 10 mg for the primary prevention of myocardial infarction in Iranian men.

BackgroundSeveral clinical trials and meta-analyses have shown the advantageous effects of statins in populations with different levels of cardiovascular disease (CVD) risk. Considering the increasing cardiovascular risk among the Iranian population, the cost-effectiveness of the use of simvastatin 10 mg, as an Over-The-Counter (OTC) drug, for the primary prevention of myocardial infarction (MI) was evaluated in this modeling study, from the payer's perspective. The target population is a hypothetical cohort of 45-year CVD healthy men with an average (15 %) 10-year CVD risk.MethodsA semi-Markov model with a life-long time horizon was developed to evaluate the Cost-Utility-Analysis (CUA) and Cost-Effectiveness-Analysis (CEA) of the use of OTC simvastatin 10 mg compared to no-drug therapy. Two measures of benefits were used in the model; Quality-Adjusted-Life-Years (QALYs) for the CUA and Life-Years-Gained (LYG) for the CEA. To examine the robustness of the results, one-way sensitivity analysis and probabilistic sensitivity analysis were applied to the model.ResultsFor the base-case scenario with a discount rate of 0 % the estimated ICERs were 1113 USD/QALY and 935USD/LYG per patient (using governmental tariffs).No threshold has been determined in Iran for the cost-effectiveness of health-related interventions. However, according to the recommendation of WHO, this intervention can be considered highly cost-effective as its ICER is far less than the reported GDP per capita for Iran by World bank in 2013 ($4763).ConclusionsThis modeling study showed that the use of an OTC low dose statin (simvastatin 10 mg) for the primary prevention of myocardial infarction (MI) in 45-year men with a 10-year CVD risk of 15 % could be considered highly cost-effective in Iran, as it meets the WHO threshold of the annual GDP per capita ($4763).

Population Trends in Aspirin Use for Cardiovascular Disease Prevention 1980-2009: The Minnesota Heart Survey.

BackgroundDaily low‐dose aspirin is recommended for primary prevention of myocardial infarction and stroke in higher‐risk patients. Population trends in aspirin use for cardiovascular disease (CVD) prevention in an urban population (Minneapolis/St. Paul, 2010 population 2.85 million) from 1980 to 2009 were evaluated.Methods and ResultsSurveys of randomly selected adults aged 25 to 74 years were collected at 5‐year intervals. Self‐reports of regular aspirin use for CVD prevention and history of CVD were obtained. Six cross‐sectional surveys included 12 281 men and 14 258 women. Age‐adjusted aspirin use for primary prevention increased during this period from 1% to 21% among men and 1% to 12% among women. Aspirin use was highest in those aged 65 to 74 years. For secondary prevention, age‐adjusted aspirin use increased from 19% to 74% among men and 11% to 64% among women. While data are based on self‐report, a substudy using a biochemical indicator of aspirin use (serum thromboxane B2) supports the validity of self‐report.ConclusionsAspirin for CVD prevention is commonly used by a large and growing portion of the general population. It is not known if this is based on professional advice or self‐prescribed use. It is also likely that many who would benefit do not use aspirin and others use aspirin inappropriately.

Aspirin Use for the Primary Prevention of Myocardial Infarction Among Men in North Carolina, 2013.

IntroductionThe US Preventive Services Task Force recommends aspirin use for men aged 45 to 79, when the potential benefit of preventing myocardial infarctions outweighs the potential harm of gastrointestinal hemorrhage. We determined prevalence and predictors of aspirin use for primary prevention of myocardial infarction vis-à-vis risk among men aged 45 to 79 in North Carolina.MethodsThe study used data for men aged 45 to 79 without contraindications to aspirin use or a history of cardiovascular disease from the 2013 North Carolina Behavioral Risk Factor Surveillance System survey. Stratification by risk of myocardial infarction was based on history of diabetes, high cholesterol, high blood pressure, and smoking. Analyses were performed in Stata version 13.0 (StataCorp LP); survey commands were used to account for complex sampling design.ResultsMost respondents, 74.2% (95% confidence interval [CI], 71.2%–77.0%), had at least one risk factor for myocardial infarction. Prevalence of aspirin use among respondents with risk factors was 44.8% (95% CI, 41.0–48.5) and was significantly higher than the prevalence among respondents without risk factors (prevalence ratio: 1.44 [95% CI, 1.17–1.78]). No significant linear dose (number of risk factors)–response (taking aspirin) relationship was found (P for trend = .25). Older age predicted (P = .03) aspirin use among respondents with at least one myocardial infarction risk factor.ConclusionMost men aged 45 to 79 in North Carolina have at least one risk factor for myocardial infarction, but less than half use aspirin. Interventions aimed at boosting aspirin use are needed among at-risk men in North Carolina.

Aspirin Use for the Primary Prevention of Myocardial Infarction Among Men in North Carolina, 2013

Aspirin Use for the Primary Prevention of Myocardial Infarction Among Men in North Carolina, 2013

Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study

BackgroundAdherence to a combination of healthy dietary and lifestyle practices may have an impressive impact on the primary prevention of myocardial infarction (MI). ObjectivesThe aim of this study was to examine the benefit of combined low-risk diet and healthy lifestyle practices on the incidence of MI in men. MethodsThe population-based, prospective cohort of Swedish men comprised 45- to 79-year-old men who completed a detailed questionnaire on diet and lifestyle at baseline in 1997. In total, 20,721 men with no history of cancer, cardiovascular disease, diabetes, hypertension, or high cholesterol levels were followed through 2009. Low-risk behavior included 5 factors: a healthy diet (top quintile of Recommended Food Score), moderate alcohol consumption (10 to 30 g/day), no smoking, being physically active (walking/bicycling ≥40 min/day and exercising ≥1 h/week), and having no abdominal adiposity (waist circumference <95 cm). ResultsDuring 11 years of follow-up, we ascertained 1,361 incident cases of MI. The low-risk dietary choice together with moderate alcohol consumption was associated with a relative risk of 0.65 (95% confidence interval [CI]: 0.48 to 0.87) compared with men having 0 of 5 low-risk factors. Men having all 5 low-risk factors compared with those with 0 low-risk factors had a relative risk of 0.14 (95% CI: 0.04 to 0.43). This combination of healthy behaviors, present in 1% of the men, could prevent 79% (95% CI: 34% to 93%) of the MI events on the basis of the study population. ConclusionsAlmost 4 of 5 MIs in men may be preventable with a combined low-risk behavior.

Abstract 226: Adherence to Aspirin Therapy for Primary Prevention of Coronary Artery Disease and Cerebrovascular Accidents

Cardiovascular disease is the leading cause of death in the United States. One simple, overlooked, and easily available therapy can reduce this risk: aspirin. Low dose aspirin reduces the risk of first time myocardial infarction (MI) in men and ischemic stroke (CVA) in women. The American Heart Association recommends anti-platelet therapy for those with an ASCVD (atherosclerotic cardiovascular disease) risk score&gt; 7.5%. The aim of our study was to determine adherence to guidelines regarding aspirin therapy for primary prevention of myocardial infarction and stroke in our resident clinic. A retrospective chart review of randomized patients with risk factors for CAD and CVA seen at Ambulatory Center in Newark, NJ, between 5/1/12 and 10/29/13 was conducted. Those with contraindications to aspirin therapy were excluded. Over 400 charts were reviewed; 281 met inclusion criteria. Per chart review, only 30% (84/281) of all at-risk patients were taking aspirin. When assessing various risk factors, 44.9% (35/78) of males ages 45-79; 24% (28/116) of females ages 55-79 (95% Confidence Interval [CI] = +-5.9%); 35.7% (51/143) of those with 10-year ASCVD risk score greater than 7.5% (95% CI = +-7.9%); 36.1% (39/108) of diabetic patients (95% CI 95% = +-9.2%); 32.8% (66/201) of those on anti-hypertensive medication (95% CI = +- 6.5%) and 29.3% (36/123) of those with a smoking history were taking aspirin (95% CI = +-8.2%). Of note, the number of women taking aspirin was statistically low as compared to men across all risk factors except for ASCVD score (p&lt;0.01). This study revealed poor adherence to guidelines with regards to use of aspirin for primary prevention of cardiovascular disease and stroke in our resident clinic. In particular, adherence to aspirin therapy for women was strikingly low. However, our estimate may be somewhat low due to improper documentation of over the counter medications. We are implementing interventions to increase awareness of aspirin use such as educational campaigns for patients, mini-lectures for ambulatory resident cohorts, automated EMR reminders and adding aspirin therapy to health maintenance smart texts to achieve our goal of 100% compliance.

Relationship between universal health outcome priorities and willingness to take medication for primary prevention of myocardial infarction.

To determine how well universal health outcome priorities represent individuals' preferences in specific clinical situations. Observational cohort study. Community. Community-dwelling adults aged 65 and older (N=357). Participants used three tools assessing universal health outcome priorities related to two common trade-offs: quality versus quantity of life and future health versus present inconveniences and burdens of treatment. The tools' ability to identify participants who were unwilling to take a medication that reduced the risk of myocardial infarction but caused dizziness and fatigue was analyzed. There were consistent and significant associations between unwillingness to take the medication and prioritizing quality of life or future health for all three tools in the expected direction (P<.05). Despite these associations, the positive (PPV) and negative predictive values for the tools were generally modest (0.49-0.83). The tool with the most specific statements resembling the medication scenario had the best specificity (0.97) and PPV (0.83). Universal health outcome priorities only modestly identified older persons who would be unwilling to take a medication for primary prevention of myocardial infarction that causes adverse effects. Although tools that are the most general in their assessment of priorities have the benefit of being applicable across the widest range of scenarios, tools with greater specificity may be necessary to inform individual treatment decisions.

Myocardial infarction and gastro-intestinal bleeding risks associated with aspirin use among elderly individuals with type 2 diabetes

Introduction. The benefit of aspirin in primary prevention of myocardial infarction and the associated gastro-intestinal bleeding risks have not been well established in the elderly population with diabetes.Methods. Using Quebec administrative databases, we conducted two nested case-control analyses within a cohort of individuals aged ≥ 66 years newly treated with an oral antidiabetes drug between 1998 and 2003. The 28,067 individuals had no cardiovascular disease recorded in the database in the year prior cohort entry. They had not used prescribed aspirin, antiplatelet, or anticoagulant drugs, and were not hospitalized for gastro-intestinal bleeding in the year prior cohort entry. The odds of myocardial infarction and gastro-intestinal bleedings were compared between individuals who were current, past, or non-users of aspirin.Results. There were 1101 (3.9%) cases of myocardial infarction. Compared to non-users, neither aspirin users (OR 0.89; 95% CI 0.71–1.13) nor aspirin past users (0.81; 0.62–1.06) showed a statistically significant lower risk of myocardial infarction. There were 373 (1.3%) cases of gastro-intestinal bleeding. Current users of aspirin had about a 2-fold greater risk of gastro-intestinal bleeding compared to non-users (2.19; 1.53–3.13).Conclusions. Our results suggest that individual assessment of bleeding risk and cardiovascular risk is mandatory among elderly people with diabetes before introducing aspirin therapy.