Aspirin and antiplatelet drugs in the prevention of cardiovascular complications of diabetes

Alberto Zanchetti

Research output: Chapter in Book/Report/Conference proceedingChapter


Type-2 diabetes mellitus is known to increase dramatically the risk of cardiovascular death, as shown, among several other studies, in the large cohort of 340,000 men screened in the Multiple Risk Factor Intervention Trial [1]. Useful information has also been provided by the Hypertension Optimal Treatment (HOT) study [2], with analyses comparing cardiovascular outcomes in 1,503 diabetic hypertensives and 17,230 non-diabetic hypertensives, all subjected to intense antihypertensive treatment: incidences of myocardial infarction, stroke, all major cardiovascular events, cardiovascular and all-cause mortalities were much higher in diabetics than in non-diabetics with relative risk of 1.45-2.13 even after adjusting for all other baseline risk factors (Fig. 1). Calculations from a recent meta-analysis of antihypertensive treatment trials [3] in 34,148 diabetics and 107,605 non-diabetics showed incidence of major cardiovascular events was 60% greater and that of cardiovascular mortality 85% greater in diabetics (Fig. 2). It is therefore reasonable to recommend that patients with diabetes be considered as "coronary heart disease risk equivalents" [4], although they may be more properly defined as "cardiovascular disease equivalents." A considerable body of evidence has accumulated about the benefits of antiplatelet therapy, in most cases aspirin, in patients with a previous cardiovascular event (previous myocardial infarction, acute myocardial infarction, previous stroke or transient ischemic attack). The 2002 collaborative meta-analysis of the Antithrombotic Trialists' Collaboration has calculated a reduction between 22% and 25% of all cardiovascular events in patients receiving antiplatelet therapy [5]. This meta-analysis involved as many as 287 studies and 135,000 patients at high risk, and in view of the high risk represented by diabetes it is somewhat surprising that only 9 studies involving few more than 5,000 patients were specifically on diabetes. Other data on the effects of aspirin in diabetic patients are available from subgroup analyses of a few trials of antiplatelet therapy in individuals free of previous cardiovascular events (so-called "primary prevention" trials), but not all these trials have separately analysed outcomes in diabetics. Surprisingly, some of the antiplatelet therapy studies on diabetics have given insufficient attention to the possible harmful effects of antiplatelet activity, namely excessive bleeding, thus making clinical conclusions even more difficult.

Original languageEnglish
Title of host publicationPharmacotherapy of Diabetes: New Developments: Improving Life and Prognosis for Diabetic Patients
PublisherSpringer US
Number of pages8
ISBN (Print)9780387697369
Publication statusPublished - 2007


  • antiplatelet drugs
  • Aspirin
  • bleeding
  • myocardial infarction
  • stroke

ASJC Scopus subject areas

  • Medicine(all)


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