Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Preventive Medicine
Effect of Low-Dose Aspirin on Primary Prevention of Cardiovascular Events in Japanese Diabetic Patients at High Risk
Sadanori OkadaTakeshi MorimotoHisao OgawaMio SakumaHirofumi SoejimaMasafumi NakayamaSeigo SugiyamaHideaki JinnouchiMasako WakiNaofumi DoiManabu HoriiHiroyuki KawataSatoshi SomekawaTsunenari SoedaShiro UemuraYoshihiko Saitoinvestigators for the Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) trial
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2013 年 77 巻 12 号 p. 3023-3028

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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.  (Circ J 2013; 77: 3023–3028)

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© 2013 THE JAPANESE CIRCULATION SOCIETY
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