Prescribing Aspirin for Primary Prevention and Risk Factors of Cardiovascular Events in Diabetic Patients at Huaiyot Hospital, Trang Province

Authors

  • Parinda Kongprasom huaiyot hospital,Huaiyot Trang 92130
  • Chattima Ongpalakorn
  • Tapanan Prateepko
  • Rosmalin Thotham
  • Jarumon Lukkanawiwat
  • Mayuree Lakkanasirorat
  • Supreeya Tirapat
  • Panitsara Thongrit

Keywords:

Aspirin, Cardiovascular disease, Primary prevention, Diabetic patient

Abstract

Background: Cardiovascular diseases (CVDs), including coronary heart disease and stroke, are a major cause of death in many countries. Currently, using aspirin, an antiplatelet, is recommended to prevent CVDs in diabetic patients but there are still no clear benefits for primary prevention.

Objectives: To compare the incidence of cardiovascular diseases between received aspirin and non-received aspirin groups among diabetic patients without prior CVDs, to identify risk factors for CVD outcomes and to find out the adherence to the American Diabetic Association (ADA) guidelines for aspirin therapy in primary prevention among diabetic patients.

Materials and methods: Retrospective data review was conducted by assessing electrical medical records from January 2012 to 2017. The main interesting risk factors and aspirin used and non-used data were extracted. The outcomes were the new event of CVDs. The processes of data collection and validation following the inclusion and exclusion criteria were performed by the diabetic patient care team. Data analyses were performed by t-test, chi-square test, and multiple logistic regressions.

Results: 1,671 diabetic patients were finally enrolled in the study. Aspirin using increased risk of CVDs, with adjusted OR of 1.16 (95% CI,0.80-1.69), but not statistical significance. Albuminuria, duration of DM more than 10 years and comorbidity with hypertension and dyslipidemia increased the risk of CVDs with adjusted OR of 1.88(95%CI,1.31-2.71), 1.48(95%CI, 1.01-2.25), 3.34 (95%CI,1.75-6.38), 3.89(95%CI,2.00-7.35), respectively. Eighteen point six percent of the subjects were overused aspirin following the ADA recommendation.

Conclusions: The use of low-dose aspirin was likely increased the risk of CVDs in diabetic patients without prior CVDs, but not statistical significance. There is some overuse of aspirin for primary prevention. Doctors should pay attention to other comorbidities such as hypertension and dyslipidemia, especially in a patient with albuminuria and long duration of DM more than 10 years.

References

1. World Health Organization. Atlas of heart disease and stroke[Internet]. 2015[cited 2018 Apr 15]. Available from:https://www.who.int/cardiovascular_diseases/resources/atlas/en/
2. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2224-60
3. World Health Organization. Non communicable diseases (NCD) country profiles [Internet]. 2014 [cited 2018 Feb 2]. Available fromhttps://www.who.int/nmh/countries/tha_en.pdf
4. Pignone M, Alberts MJ, Colwell JA, Cushman M, Inzucchi SE, Mukherjee D, et al. Aspirin for primary prevention of cardiovascular events in people with diabetes: a position statement of the American Diabetes Association, a scientific statement of the American Heart Association, and an expert consensus document of the American College of Cardiology Foundation. Circulation. 2010;121(24):2694-701.
5. Guirguis-Blake JM, Evans CV, Senger CA, et al. Aspirin for the Primary Prevention of Cardiovascular Events: A Systematic Evidence Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2015 Sep. (Evidence Syntheses, No. 131.) References [cited 2018 Feb 3].Available from:https://www.ncbi.nlm.nih.gov/books/NBK321630/
6. American Diabetes Association. Standard of medical care in diabetes-2014. Diabetes Care[Internet]. 2014 [cited 2018 Feb 4];37(Supplement 1):S14-80. Available fromhttps://doi.org/10.2337/dc14-S014
7. Fifth Joint Task Force of the European Society of C, European Association of E, European Association of Percutaneous Cardiovascular I, European Heart Rhythm A, Heart Failure A, European Association for Cardiovascular P, et al. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). European journal of preventive cardiology. 2012;19(4):585-667.
8. 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(18):2134-41.
9. 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(10):e90286.
10. Yang ZJ, Liu J, Ge JP, Chen L, Zhao ZG, Yang WY, et al. Prevalence of cardiovascular disease risk factor in the Chinese population: the 2007-2008 China National Diabetes and Metabolic Disorders Study. European heart journal. 2012;33(2):213-20.
11. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2014;63(25 Pt B):2889-934.
12. de Jong PE, Gansevoort RT, Bakker SJ. Macroalbuminuria and microalbuminuria: do both predict renal and cardiovascular events with similar strength? Journal of Nephrology. 2007;20(4):375-80.
13. Rossing P, Hougaard P, Borch-Johnsen K, Parving HH. Predictors of mortality in insulin dependent diabetes: 10 years observational follow up study. BMJ. 1996;313(7060):779-84.
14. de Zeeuw D, Remuzzi G, Parving HH, Keane WF, Zhang Z, Shahinfar S, et al. Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy. Circulation. 2004;110(8):921-7.
15. Morrish NJ, Stevens LK, Fuller JH, Jarrett RJ, Keen H. Risk factors for macrovascular disease in diabetes mellitus: the London follow-up to the WHO Multinational Study of Vascular Disease in Diabetics. Diabetologia. 1991;34(8):590-4.
16. VanWormer JJ, Miller AW, Rezkalla SH. Aspirin overutilization for the primary prevention of cardiovascular disease. Clinical epidemiology. 2014;6:433-40.

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Published

2019-08-07

Issue

Vol. 1 No. 1 (2019): January-April, 2019

Section

Research Articles

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