Aspirin should not routinely be used to prevent cardiovascular events in diabetics

Aspirin should not be routinely prescribed to diabetics for the prevention of heart attack and stroke, say researchers.

The Prevention of Progression of Arterial Disease and Diabetes (POPADAD) Trial involved 1,276 people with type 1 or type 2 diabetes who had no symptoms of coronary heart disease. Participants were randomly assigned to receive either a daily 100 mg aspirin tablet plus antioxidant capsule, an aspirin tablet plus placebo capsule, a placebo tablet plus antioxidant capsule (n=320), or a placebo tablet plus placebo capsule.

Results showed that aspirin – taken alone or in combination with an antioxidant capsule – did not significantly reduce the risk of death from coronary heart disease or stroke, or non-fatal myocardial infarction or stroke.

The researchers conclude: “This trial does not provide evidence to support the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality.” However, these findings are not applicable to everyone. Previous studies have shown that aspirin can reduce the risk of future heart attack or stoke in people with established coronary artery disease by approximately 25%.

In an accompanying editorial, William R Hiatt, a professor of medicine at the University of Colorado Denver School of Medicine, writes that these findings, together with those of 6 other trials, suggest that international guidelines and the prescribing practice of doctors should be reviewed so that aspirin is only prescribed to patients with established cardiovascular disease.
    
Belch J, MacCuish A, Campbell I, et al. The prevention of progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in patients with diabetes and asymptomatic peripheral arterial disease. BMJ 2008;337:a1840.

Hiatt WR. Aspirin for prevention of cardiovascular events (editorial). BMJ 2008;337:a1806