title: Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: updated meta-analysis of randomized controlled trials.
abstract: To evaluate the benefits and harms of aspirin for the primary prevention of cardiovascular disease and all-cause mortality events in people with diabetes by conducting a systematic review and meta-analysis.
  
  
  
  Randomized controlled trials of aspirin compared with placebo (or no treatment) in people with diabetes with no history of cardiovascular disease were identified from MEDLINE, EMBASE, Web of Science, the Cochrane Library and a manual search of bibliographies to November 2015. Study-specific relative risks with 95% CIs were aggregated using random effects models.
  
  
  
  A total of 10 randomized trials were included in the review. There was a significant reduction in risk of major adverse cardiovascular events: relative risk of 0.90 (95% CI 0.81-0.99) in groups taking aspirin compared with placebo or no treatment. Limited subgroup analyses suggested that the effect of aspirin on major adverse cardiovascular events differed by baseline cardiovascular disease risk, medication compliance and sex (P for interaction for all > 0.05).There was no significant reduction in the risk of myocardial infarction, coronary heart disease, stroke, cardiovascular mortality or all-cause mortality. Aspirin significantly reduced the risk of myocardial infarction for a treatment duration of ≤ 5 years. There were differences in the effect of aspirin by dosage and treatment duration on overall stroke outcomes (P for interaction for all < 0.05). There was an increase in risk of major or gastrointestinal bleeding events, but estimates were imprecise and not significant.
  
  
  
  The emerging data do not clearly support guidelines that encourage the use of aspirin for the primary prevention of cardiovascular disease in adults with diabetes who are at increased cardiovascular disease risk.
authors.affiliation: School of Clinical Sciences, University of Bristol, Southmead Hospital, Southmead, UK.
authors.forename: S K
authors.initials: SK
authors.lastname: Kunutsor
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.|Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK.
authors.forename: S
authors.initials: S
authors.lastname: Seidu
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Leicester, UK.|Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
mesh_terms: D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D058065:Diabetic Cardiomyopathies / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D006801:Humans; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D012720:Severity of Illness Index; D020521:Stroke / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control
chemical_list: D010975:Platelet Aggregation Inhibitors; D001241:Aspirin