title: Effect of low-dose aspirin on primary prevention of cardiovascular events in Japanese diabetic patients at high risk.
abstract: 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.
  
  
  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 (81-100 mg 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.
authors.affiliation: First Department of Internal Medicine, Nara Medical University.
authors.forename: Sadanori
authors.initials: S
authors.lastname: Okada
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
authors.forename: Mio
authors.initials: M
authors.lastname: Sakuma
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Soejima
authors.forename: Masafumi
authors.initials: M
authors.lastname: Nakayama
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Hideaki
authors.initials: H
authors.lastname: Jinnouchi
authors.forename: Masako
authors.initials: M
authors.lastname: Waki
authors.forename: Naofumi
authors.initials: N
authors.lastname: Doi
authors.forename: Manabu
authors.initials: M
authors.lastname: Horii
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawata
authors.forename: Satoshi
authors.initials: S
authors.lastname: Somekawa
authors.forename: Tsunenari
authors.initials: T
authors.lastname: Soeda
authors.forename: Shiro
authors.initials: S
authors.lastname: Uemura
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Saito
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D044466:Asian People; D001241:Aspirin / Q000008:administration & dosage*; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D048909:Diabetes Complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin