Evaluation of prophylaxis in primary prevention with acetylsalicylic acid in people with diabetes: A scoping review.

Autor:	Ruiz-García A; Family Medicine, Pinto University Health Center, Pinto, Madrid, Spain; European University of Madrid, Villaviciosa de Odón, Madrid, Spain., Pallarés-Carratalá V; Family Medicine, Health Surveillance Unit, Mutual Insurance Union, Castellón, Spain; Medicine Department, Jaume I University, Castellón, Spain. Electronic address: pallares.vic@gmail.com., Serrano-Cumplido A; Family Medicine, Getxo, Bizkaia, Spain., Escobar-Cervantes C; Cardiology Service, La Paz University Hospital, Madrid, Spain., Barquilla-García A; Family Medicine, Trujillo Primary Care Team, Clinics of Herguijuela and Conquista de la Sierra), Cáceres, Spain., Divisón-Garrote JA; Family Medicine, Casas Ibáñez Health Center, Fuentealbilla Clinic, Albacete, Spain., Turégano-Yedro M; Family Medicine, Aldea Moret Health Center, Cáceres, Spain., Prieto-Díaz MA; Family Medicine, Vallobín - La Florida Health Center, Oviedo, Spain., Cinza-Sanjurjo S; Family Medicine, Porto do Son Health Center, Santiago de Compostela Health Area, Santiago de Compostela, Spain; Center for Biomedical Research Network on Cardiovascular Diseases (CIBERCV), Madrid, Spain., Alonso-Moreno FJ; Family Medicine, Sillería Health Center, Toledo, Spain., Beato-Fernández P; Family Medicine, Premia de Mar Primary Care Center, Catalan Institute of Health, Barcelona, Spain., García-Matarín L; Family Medicine, Aguadulce Sur Health Center, Roquetas de Mar, Almería, Spain., Rey-Aldana D; Family Medicine, Estrada Health Center, Pontevedra, Spain; USC-SEMERGEN Chair, University of Santiago de Compostela, Santiago de Compostela, Spain., Martín-Rioboó E; Family Medicine, Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), Reina Sofía Hospital, Poniente clinical management unit, Córdoba, Spain., Moyá-Amengual A; Occupational Medicine, Santa Catalina Health Center, Palma de Mallorca, Islas Baleares, Spain., Crespo-Sabarís R; Family Medicine, Primary Care Management of La Rioja Health Service, Logroño, La Rioja, Spain., Piera-Carbonell A; Family Medicine, Luanco Health Center, Gozón, Asturias, Spain., Romero-Vigara JC; Family Medicine, Corella Health Center, Corella, Navarra, Spain., Carrasco-Carrasco E; Family Medicine, Abaran Health Center, Murcia, Spain., Velilla-Zancada S; Family Medicine, Joaquín Elizalde Health Center, Logroño, Spain., Seoane-Vicente MC; Family Medicine, Acequión Health Center, Torrevieja, Alicante, Spain., Górriz-Teruel JL; Nephrology Service, University Clinical Hospital, Valencia, Spain; School of Medicine, University of Valencia, Valencia, Spain., Polo-García J; Family Medicine, Casar de Cáceres Health Center, Cáceres, Spain., Barrios V; Cardiology Service, Ramón y Cajal University Hospital, Madrid, Spain; University of Alcalá, Madrid, Spain.
Jazyk:	angličtina
Zdroj:	Semergen [Semergen] 2022 May-Jun; Vol. 48 (4), pp. 275-292. Date of Electronic Publication: 2022 Feb 15.
DOI:	10.1016/j.semerg.2021.12.002
Abstrakt:	Background: The efficacy and safety of acetylsalicylic acid (ASA) prophylaxis for the primary prevention of atherosclerotic cardiovascular disease (ACVD) remain controversial in people with diabetes (DM) without ACVD, because the possible increased risk of major bleeding could outweigh the potential reduction in the risk of mortality and of major adverse cardiovascular events (MACE) considered individually or together. Objective: To evaluate the overall risk-benefit of ASA prophylaxis in primary prevention in people with DM and to compare the recommendations of the guidelines with the results of the meta-analyses (MA) and systematic reviews (SR). Material and Methods: We searched Medline, Google Scholar, Embase, and the Cochrane Library for SR and MA published from 2009 to 2020 which compared the effects of ASA prophylaxis versus placebo or control followed up for at least one year in people with DM without ACVD. Heterogeneity among the randomized clinical trials (RCT) included in the SR and MA was assessed. Cardiovascular outcomes of efficacy (all-cause mortality [ACM], cardiovascular mortality [CVM], myocardial infarction [MI], stroke and MACE) and of safety (major bleeding events [MBE], major gastrointestinal bleeding events [MGIBE], and intracranial and extracranial bleeding) were shown. Results: The recommendations of 12 guidelines were evaluated. The results of 25 SR and MA that included a total of 20 RCT were assessed. None of the MA or SR showed that ASA prophylaxis decreased the risk of ACM, CVM or MI. Only two of the 19 SR and MA that evaluated ischemic stroke showed a decrease in the stroke risk (mean 20.0% [SD±5.7]), bordering on statistical significance. Almost half of the MA and SR showed, bordering on statistical significance, a risk reduction for the MACE composite endpoint (mean 10.5% [SD±3.3]). The significant increases in MGIBE risk ranged from 35% to 55%. The significant increases in the risk of MBE and extracraneal bleeding were 33.4% (SD±14.9) and 54.5% (SD±0.7) respectively. Conclusion: The overall risk-benefit assessment of ASA prophylaxis in primary prevention suggests that it should not be applied in people with DM. (Copyright © 2022 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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