Aspirin not needed for primary CV prevention in diabetes: AS
Aspirin prevented serious vascular events in patients with diabetes who did not already have cardiovascular disease, but it caused almost as many major bleeds and there was no effect on cancers. These are the late-breaking findings presented at ESC Congress 2018 and have been published simultaneously in the New England Journal of Medicine.

The ASCEND trial (A Study of Cardiovascular Events iN Diabetes) examined whether aspirin reduced the risk of a first cardiovascular event in patients with diabetes. Between 2005 and 2011, 15,480 patients with diabetes but no history of cardiovascular disease were randomly assigned to aspirin (100 mg daily) or matching placebo.

Serious health outcomes that occurred to participants during follow-up were then recorded, including in particular:
• First serious vascular event (the primary efficacy endpoint), which included non-fatal heart attacks, non-fatal strokes or transient ischaemic attacks (sometimes called “mini-strokes”), or death from a cardiovascular cause (but excluding any intracranial haemorrhage, i.e. bleeding in the head or brain); and

• First major bleed (the primary safety endpoint), which included bleeding in the head or brain, from the gut or from elsewhere in the body that was serious enough to result in hospitalisation or be fatal.

“We have shown conclusively in ASCEND that aspirin reduces the risk of vascular events in primary prevention, as it does in people who already have cardiovascular disease, but these benefits are counter-balanced by the number of major bleeds caused by aspirin. This is an important finding with implications for many millions of people who have diabetes but have not yet had cardiovascular events. Current clinical guidelines vary in their recommendations about the use of aspirin for primary prevention because of a previous lack of clear evidence. The results of ASCEND now provide much needed clarity.” the authors have said.

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The original study can be read here: