5 ปีของการใช้ aspirin เพื่อป้องกันการเกิดโรคหัวใจและหลอดเลือด แบบปฐมภูมิในผู้ป่วยโรคเบาหวานชนิดที่ 2
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มิ.ย. 24, 2019
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แอสไพริน โรคเบาหวานชนิดที่ 2 โรคหัวใจและหลอดเลือด
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บทคัดย่อ
วัตถุประสงค์: เพื่อประเมินผลการได้รับ aspirin ในการป้องกันการเกิดโรคหัวใจและหลอดเลือดแบบปฐมภูมิในผู้ป่วยเบาหวานชนิดที่ 2 และอาการไม่พึงประสงค์ต่อระบบทางเดินอาหารจากการใช้ aspirin วิธีการ: การศึกษานี้เป็นการวิจัยแบบ retrospective cohort ซึ่งเก็บข้อมูล ณ โรงพยาบาลมหาสารคาม ในช่วง 1 มกราคม พ.ศ. 2549 ถึง 31 ธันวาคม พ.ศ. 2559 ผู้ป่วยแต่ละรายถูกติดตามเป็นเวลาอย่างน้อย 5 ปี ผู้ป่วยที่มีคุณสมบัติตามเกณฑ์การคัดเลือกมีจำนวน 1,302 คน แบ่งเป็นกลุ่มผู้ป่วยที่ใช้ aspirin 762 คน (ร้อยละ 58.53) และกลุ่มผู้ป่วยที่ไม่ใช้ aspirin 540 คน (ร้อยละ 41.47) ผลการวิจัย: การใช้ยา aspirinในผู้ป่วยเบาหวานชนิดที่ 2 ไม่มีผลลดอัตราการเกิดโรคหัวใจและหลอดเลือดได้ ไม่ว่าจะเป็นการเกิดโรคหัวใจและหลอดเลือดทั้งหมด (HR 1.00, 95% CI; 0.89-1.11) กล้ามเนื้อหัวใจตาย (HR 1.00, 95% CI; 0.90-1.12) โรคหลอดเลือดสมอง (HR 1.00, 95% CI; 0.90-1.12) และโรคหัวใจขาดเลือด (HR 0.99, 95% CI; 0.89-1.11) นอกจากนี้ยังไม่เพิ่มความเสี่ยงในการเกิดภาวะเลือดออก สรุป: aspirin ไม่มีประโยชน์ในการลดอัตราการเกิดโรคหัวใจและหลอดเลือดในผู้ป่วยเบาหวานชนิดที่ 2 แต่อย่างไรก็ตามควรมีการศึกษาเพิ่มเติมในกลุ่มประชากรที่ใหญ่ขึ้น เพื่อยืนยันผลการศึกษาของผู้ป่วยไทย
Article Details
บท
บทความวิจัย
ผลการวิจัยและความคิดเห็นที่ปรากฏในบทความถือเป็นความคิดเห็นและอยู่ในความรับผิดชอบของผู้นิพนธ์ มิใช่ความเห็นหรือความรับผิดชอบของกองบรรณาธิการ หรือคณะเภสัชศาสตร์ มหาวิทยาลัยสงขลานครินทร์ ทั้งนี้ไม่รวมความผิดพลาดอันเกิดจากการพิมพ์ บทความที่ได้รับการเผยแพร่โดยวารสารเภสัชกรรมไทยถือเป็นสิทธิ์ของวารสารฯ
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13. Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016; 164: 826-35.
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15. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collabora- tive meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60.
16. Butalia S, Leung AA, Ghali WA, Rabi DM. Aspirin effect on the incidence of major adverse cardiovascu lar events in patients with diabetes mellitus: a systematic review and meta analysis. Cardiovasc Diabetol 2011;10: 25.
17. Zhang C, Sun A, Zhang P, Wu C, Zhang S, Fu M, et al. Aspirin for primary prevention of cardiovascular events in patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2010;87:211-8.
18. De Berardis G, Sacco M, Strippoli GF, Pellegrini F, Graziano G, Tognoni G, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. BMJ 2009; 339: 4531.
19. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes 2019.[online]. 2019 [cited Jan 10, 2019]. Available from: care.dia betesjournals.org/content/42/Supplement_1/S103.long
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21. Kim YJ, Choi NK, Kim MS, Lee J, Chang Y, Seong JM, et al. Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study. Diabetol Metab Syndr 2015; 7:8. doi: 10.1186/s13098-015-0002-y.
22. Grundy SM. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation 2002; 106: 3143-421.
23. Stehouwer CD, Smulders YM. Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms. J Am Soc Nephrol 2006;17: 2106 -11.
24. Saito Y, Okada S2, Ogawa H, Soejima H, Sakuma M, Nakayama M, et al. Low-dose aspirin for primary prevention of cardiovascular events in patients with type 2 diabetes mellitus 10-year follow-up of a randomized controlled trial. Circulation 2017; 135: 659–70
25. Guirguis-Blake JM, Evans CV, Senger CA, O'Connor EA, Whitlock EP. Evidence summary: aspirin use to prevent cardiovascular events. [online]. 2016 [cited Feb 10, 2016]. Available from: www.uspreventiveser vicestaskforce.org/Page/Document/evidence-summ ary-aspirin-to-prevent-cardiovascular/aspirin-to-prev ent-cardiovascular-disease-and-cancer.
26. Ferreiro JL, Angiolillo DJ. Diabetes and antiplatelet therapy in acute coronary syndrome. Circulation. 2011;123: 798-813.
27. Ertugrul DT, Tutal E, Yildiz M, Akin O, Yalçin AA, Ure OS, et al. Aspirin resistance is associated with glycemic control, the dose of aspirin, and obesity in type 2 diabetes mellitus. J Clin Endocrinol Metab 2010; 95: 2897-901.
28. Bethel MA, Harrison P, Sourij H, Sun Y, Tucker L, Kennedy I, et al. Randomized controlled trial com paring impact on platelet reactivity of twice-daily with once-daily aspirin in people with Type 2 diabetes. Diabet Med 2016; 33: 224-30.
29. Kim YJ, Choi NK, Kim MS, Lee J, Chang Y, Seong JM, et al. Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study. Diabetol Metab Syndr 2015; 7:8.
30. Okada S, Morimoto T, Ogawa H, Sakuma M, Soejima H, Nakayama M, et al. Effect of low-dose aspirin on primary prevention of cardiovascular events in Japanese diabetic patients at high risk. Circ J 2013; 77: 3023-8.
31. Belch J, MacCuish A, Campbell I, Cobbe S, Taylor R, Prescott R, 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.
32. Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008; 300: 2134-41.
33. Thongbai T. The Prevalence of gastroduodenal mucosal injuries in aspirin users. J Med Assoc Thai 2013; 96 : 1423-7.
34. Mo C, Sun G, Lu ML, Zhang L, Wang YZ, Sun X, et al. Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries. World J Gastroenterol 2015;21: 5382-92.
2. Diabetes Association of Thailand. Diabetes Incidence [online]. 2015 [cited Oct 6, 2017]. Available from: www.dmthai.org/news_and_knowledge/1300.
3. Strategy and Planning Division, Ministry of Public Health. Number and rate of diabetes patients per 100,000 populations from 2007 to 2015. [online]. 2015 [cited Oct 6, 2016]. Available from: www.thaincd.com/information-statistic/non-communicable-disease-data.php
4. Permngaam K. Diabetes mellitus [online]. 2011 [cited Jan 25, 2016]. Available from: allied.tu.ac.th/ MedicalTechnology/Documents/Articles/Articles_mt_ gen_KanyanatP_2554_06_29.pdf
5. Arbsuwan N, Panthrawet N. World diabetes day campaign about topic of diabetes 2014 (Fiscal year 2015). [online]. 2014 [cited Jan 25, 2015]. Available from: www.thaincd.com/document /hot%20news/ ประเด็นเบาหวาน58.doc.
6. Khoury JC, Kleindorfer D, Alwell K, Moonmaw CJ, Woo D, Adeoye O, et al. Diabetes mellitus: a risk factor for ischemic stroke in a large bi-racial population. Stroke 2013; 44: 1500-4.
7. International Diabetes Federation. Complications of diabetes [online] 2016. [cited Feb10, 2016]. Available from: www.diabetes.org/complications-diabetes.
8. Ngarmukos C, Bunnag P, Kosachunhanun N, Krittiyawong S, Leelawatana R, Prathipanawatr T, et al. Thailand diabetes registry project: prevalence, characteristics and treatment of patients with diabetic nephropathy. J Med Assoc Thai 2006; 89: S 37-42.
9. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, Di Angelantonio E, Gao P, Sarwar N, et al. Diabetes mellitus fasting glucose and risk of cause-specific death. N Engl J Med. 2011; 364: 829-41.
10. Pratipanawatr T, Rawdaree P, Chetthakul T, Bunnag P, Ngarmukos C, Benjasuratwong Y, et al. Thailand Diabetes Registry Cohort: predicting death in Thai diabetic patients and causes of death. J Med Ass Thailand, 2010; 93:S12-20.
11. American Diabetes Association. Standards of medical care in diabetes–2019. Diabetes care. 2017; 40. [online]. 2019 [cited Jan 9, 2009]. Available from: care.diabetesJournals.org/content/ 42/Supplement_1/S90
12. Bunmak W. Aspirin [online]. 2014. [cite Jan 25, 2015]. Available from: www.pharmacy.mahidol.ac.th/th/ know ledge/article/257/แอสไพริน(aspirin).
13. Whitlock EP, Burda BU, Williams SB, Guirguis-Blake JM, Evans CV. Bleeding risks with aspirin use for primary prevention in adults: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2016; 164: 826-35.
14. Xie M, Shan Z, Zhang Y, Chen S, Yang W, Bao W, et al. Aspirin for primary prevention of cardiovascular events : meta-analysis of randomized controlled trials and subgroup analysis by sex and diabetes status. Plos one 2014; 9: 1-6.
15. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, et al. Aspirin in the primary and secondary prevention of vascular disease: collabora- tive meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849-60.
16. Butalia S, Leung AA, Ghali WA, Rabi DM. Aspirin effect on the incidence of major adverse cardiovascu lar events in patients with diabetes mellitus: a systematic review and meta analysis. Cardiovasc Diabetol 2011;10: 25.
17. Zhang C, Sun A, Zhang P, Wu C, Zhang S, Fu M, et al. Aspirin for primary prevention of cardiovascular events in patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2010;87:211-8.
18. De Berardis G, Sacco M, Strippoli GF, Pellegrini F, Graziano G, Tognoni G, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: meta-analysis of randomised controlled trials. BMJ 2009; 339: 4531.
19. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes 2019.[online]. 2019 [cited Jan 10, 2019]. Available from: care.dia betesjournals.org/content/42/Supplement_1/S103.long
20. V. Kasiulevičius ea. Sample size calculation in epidemiological studies. [online]. 2006 [cited Feb 10, 2018]. Available from: www.gerontologija.lt/files/edit _files/File/pdf/2006/nr_4/2006_225_231.pdf
21. Kim YJ, Choi NK, Kim MS, Lee J, Chang Y, Seong JM, et al. Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study. Diabetol Metab Syndr 2015; 7:8. doi: 10.1186/s13098-015-0002-y.
22. Grundy SM. Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III). Circulation 2002; 106: 3143-421.
23. Stehouwer CD, Smulders YM. Microalbuminuria and risk for cardiovascular disease: analysis of potential mechanisms. J Am Soc Nephrol 2006;17: 2106 -11.
24. Saito Y, Okada S2, Ogawa H, Soejima H, Sakuma M, Nakayama M, et al. Low-dose aspirin for primary prevention of cardiovascular events in patients with type 2 diabetes mellitus 10-year follow-up of a randomized controlled trial. Circulation 2017; 135: 659–70
25. Guirguis-Blake JM, Evans CV, Senger CA, O'Connor EA, Whitlock EP. Evidence summary: aspirin use to prevent cardiovascular events. [online]. 2016 [cited Feb 10, 2016]. Available from: www.uspreventiveser vicestaskforce.org/Page/Document/evidence-summ ary-aspirin-to-prevent-cardiovascular/aspirin-to-prev ent-cardiovascular-disease-and-cancer.
26. Ferreiro JL, Angiolillo DJ. Diabetes and antiplatelet therapy in acute coronary syndrome. Circulation. 2011;123: 798-813.
27. Ertugrul DT, Tutal E, Yildiz M, Akin O, Yalçin AA, Ure OS, et al. Aspirin resistance is associated with glycemic control, the dose of aspirin, and obesity in type 2 diabetes mellitus. J Clin Endocrinol Metab 2010; 95: 2897-901.
28. Bethel MA, Harrison P, Sourij H, Sun Y, Tucker L, Kennedy I, et al. Randomized controlled trial com paring impact on platelet reactivity of twice-daily with once-daily aspirin in people with Type 2 diabetes. Diabet Med 2016; 33: 224-30.
29. Kim YJ, Choi NK, Kim MS, Lee J, Chang Y, Seong JM, et al. Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study. Diabetol Metab Syndr 2015; 7:8.
30. Okada S, Morimoto T, Ogawa H, Sakuma M, Soejima H, Nakayama M, et al. Effect of low-dose aspirin on primary prevention of cardiovascular events in Japanese diabetic patients at high risk. Circ J 2013; 77: 3023-8.
31. Belch J, MacCuish A, Campbell I, Cobbe S, Taylor R, Prescott R, 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.
32. Ogawa H, Nakayama M, Morimoto T, Uemura S, Kanauchi M, Doi N, et al. Low-dose aspirin for primary prevention of atherosclerotic events in patients with type 2 diabetes: a randomized controlled trial. JAMA. 2008; 300: 2134-41.
33. Thongbai T. The Prevalence of gastroduodenal mucosal injuries in aspirin users. J Med Assoc Thai 2013; 96 : 1423-7.
34. Mo C, Sun G, Lu ML, Zhang L, Wang YZ, Sun X, et al. Proton pump inhibitors in prevention of low-dose aspirin-associated upper gastrointestinal injuries. World J Gastroenterol 2015;21: 5382-92.