| Summary: | 碩士 === 高雄醫學大學 === 藥學系臨床藥學碩士班 === 102 === Abstract
Background
International Diabetes Federation (IDF) diabetes Atlas 5th 2012 indicates that 382 million people have diabetes in global. Diabetes complications include macrovascular disease and microvascular disease. Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in diabetes patients. In 2006, American Diabetes Association (ADA) and American Heart Association (AHA) guidelines recommend that aspirin75-162mg/day is used for primary prevention of CVD in diabetes based on 10-year coronary heart disease risk. Compared to secondary prevention with key evidence on its benefits, primary prevention is still controversial in clinical use due to the potential risk in bleeding and the uncertain efficacy.
Methods
Patients with newly diagnosed diabetes between January 1, 1997 and June 1, 2010 in the longitudinal Health Insurance Database (LHID2005) were included. Patients who used aspirin or had any CVD before the diabetes diagnosis date were excluded. Patients who used more than 28 cDDDs were defined as aspirin users and others as non-aspirin users. Multivariable cox proportional hazards regression was used to estimate the efficacy and safety of aspirin for primary prevention in diabetes patients. The subgroup analysis was used for some specific populations such as glycemic control of diabetes and different dose-response.
Results
A total of 12,814 patients newly diagnosed as diabetes mellitus were analyzed. After adjustment for related covariates, aspirin users can’t reduce risk on cardiovascular composite outcome compared with non-aspirin users (HR=0.995, 95% CI=0.893-1.107). In addition, aspirin users can’t reduce risk on acute myocardial infarction (HR=1.245, 95% CI=0.798-1.941), ischemic heart disease (HR=1.363, 95% CI=0.731-2.544), ischemic stroke (HR=1.194, 95% CI=0.914-1.558). Aspirin user didn’t increase risk on hemorrhagic stroke (HR=0.736, 95%CI=0.509-1.062) and upper gastrointestinal bleeding. (HR=0.933, 95%CI=0.645-1.349) In the subgroup analysis, aspirin users with ?T5 years follow up time decreased 21% risk on CVD with statistical significance (HR=0.799, 95%CI=0.673-0.949). But aspirin users with ?? 5 years follow up time increased 23% risk of CVD (HR=1.234, 95% CI=1.073-1.418). The dose dependent analysis indicated that the highest cDDDs group (??365 cDDDs) can decrease 27% risk of CVD.
Conclusions
Among type II diabetes patients with aspirin use for primary prevention can’t reduce the risk of CVD. Subgroup analysis indicated that aspirin users with?T 5 years follow up time can reduce risk on CVD. However, aspirin users with ??5 years follow up time can’t reduce the risk of CVD. Dose relation analysis indicated that highest cDDDs group (??365 cDDDs) can reduce risk of CVD compared to ??28 cDDDs group.
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