In this article, Kunutsor, et al. (2016) examine the impact of aspirin for the primary prevention of all-cause mortality and cardiovascular events on patients with diabetes. The purpose of their research is determined by a considerable risk of cardiovascular events in people with diabetes that promote inflammation and atherosclerosis die to a particular platelet dysfunction (Kunutsor, et al., 2016). In general, cardiovascular disease may be regarded as the main cause of mortality in both male and female patients with diabetes, accounting for more than 70% of deaths (Kunutsor, et al., 2016). Despite the fact that the efficiency of low-dose aspirin for the secondary prevention of cardiovascular events in patients with additional risk factors, including diabetes, is well established, the impact of this medication for primary prevention continues to be investigated in order to decrease mortality rates.
The research implies the meta-analysis and systematic review of randomized controlled trials related to the efficacy of the use of low-dose aspirin in comparison with placebo treatment. Ten trials were identified from EMBASE, MEDLINE, the Cochrane Library, Web of Science, and other databases through both automatic and manual search and included in the research (Kunutsor, et al., 2016). All trials assessed the impact of aspirin therapy in comparison with no treatment or placebo treatment, enrolled adult patients with diabetes mellitus, and had “a follow-up duration of at least 12 months” (Kunutsor, et al., 2016, p. 2). Two independent authors initially extracted data with the help of a specific predesigned data extraction form that included study-level information, baseline population, the proportion of women and men, average age, location, the number of participants, intervention and dosage, treatment duration, and major outcomes (Kunutsor, et al., 2016). Due to the involvement of the third reviewer and the use of the Cochrane Collaboration’s risk of bias tool, the risk of potential bias was reduced to guarantee the validity and relevance of the study (Kunutsor, et al., 2016).
According to the results of the research, aspirin therapy provides “a significant reduction in risk of major adverse cardiovascular events” in comparison with no treatment or placebo treatment (Kunutsor, et al., 2016, p. 1). At the same time, “there was no significant reduction in the risk of myocardial infarction, coronary heart disease, stroke, cardiovascular mortality or all-cause mortality” (Kunutsor, et al., 2016, p. 1). However, the duration of treatment positively influences the reduction of myocardial infarction and overall stroke outcomes. Although the risk of gastrointestinal bleeding events increases, it may be regarded as insignificant and imprecise.
In comparison with previous studies, the investigation of Kunutsor, et al. (2016) provides previously unreported relevant findings. For instance, the authors discovered a modest-sized reduction in non-fatal myocardial infarction associated with the use of low-dose aspirin that may be defined as statistically significant. In addition, the difference in the impact of duration treatment on the prevention of myocardial infarction and stroke was identified as well. While aspirin reduces the risk of myocardial infarction for short average intervention periods, the risk of stroke was reduced in relatively longer average intervention periods (Kunutsor, et al., 2016). At the same time, regardless of the comprehensiveness of the meta-analysis, the number of studies for the research is substantially limited for clinically relevant results. This number may be enlarged for systematic reviews in the future in order to receive results that may be applied to evidence-based practice.
Reference
Kunutsor, S. K., Seidu, S., & Khunti, K. (2016). Aspirin for primary prevention of cardiovascular and all-cause mortality events in diabetes: Updated meta-analysis of randomized controlled trials. DIABETICMedicine, 1-12.