Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Patients With Diabetes: A Meta-Analysis Stavros Stavrakis, MD The American Journal.

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Presentation transcript:

Low-Dose Aspirin for Primary Prevention of Cardiovascular Events in Patients With Diabetes: A Meta-Analysis Stavros Stavrakis, MD The American Journal of the Medical Sciences Volume 341, Issue 1, Pages 1-9 (January 2011) DOI: 10.1097/MAJ.0b013e3181f1fba8 Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 1 Flow chart for the search for eligible studies. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 2 Forest plot of study-specific and pooled hazard ratio and 95% confidence interval for aspirin versus control (placebo or nonaspirin). (A) Summary of major cardiovascular event data, defined as death from cardiovascular causes, nonfatal myocardial infarction or nonfatal stroke, among subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. Pooled estimates are based on a random-effects model. (B) Data from the JPAD and POPADAD studies are presented but were not included in the overall combined estimate, because the composite endpoint definition for the POPADAD study also included above ankle amputation for critical limb ischemia in the composite cardiovascular endpoint and a much broader composite endpoint of sudden death, death from cardiovascular or aortic causes, nonfatal acute myocardial infarction, unstable angina, exertional angina, nonfatal ischemic and hemorrhagic stroke, transient ischemic attack, nonfatal aortic or peripheral vascular disease was used for the JPAD study. JPAD, Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes trial; POPADAD; Prevention of Progression of Arterial Disease and Diabetes study. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 3 Forest plot of study-specific and pooled hazard ratio and 95% confidence interval for aspirin versus control (placebo or nonaspirin). (A) Summary of composite nonfatal or fatal myocardial infarction among subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. (B) Summary of nonfatal myocardial infarction data from the JPAD and POPADAD studies. Pooled estimates are based on a random-effects model. JPAD, Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes trial; POPADAD; Prevention of Progression of Arterial Disease and Diabetes study. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 4 Forest plot of study-specific and pooled hazard ratio and 95% confidence interval for aspirin versus control (placebo or nonaspirin). (A) Summary of composite nonfatal or fatal stroke among subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. Summary of (B) nonfatal stroke and (C) fatal stroke data from the JPAD and POPADAD studies. Pooled estimates are based on a random-effects model. Nonfatal stroke estimates were not pooled for the JPAD and POPADAD studies because of the differences in endpoint definitions. JPAD, Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes trial; POPADAD; Prevention of Progression of Arterial Disease and Diabetes study. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 5 Forest plot of study-specific and pooled hazard ratio and 95% confidence interval for aspirin versus control (placebo or nonaspirin). Summary of cardiovascular death among subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. Pooled estimates are based on a random-effects model. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 6 Forest plot of study-specific and pooled hazard ratio and 95% confidence interval for aspirin versus control (placebo or nonaspirin). Summary of all-cause mortality subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. Pooled estimates are based on a random-effects model. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 7 Forest plot of study-specific and pooled relative risk and 95% confidence interval for aspirin versus control (placebo or nonaspirin). Summary of major bleeding among subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. Pooled estimates are based on a random-effects model. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions

Figure 8 Forest plot of study-specific and pooled relative risk and 95% confidence interval for aspirin versus control (placebo or nonaspirin). Summary of gastrointestinal bleeding among subjects with diabetes at baseline relative to aspirin or control group (placebo or nonaspirin) assignment. Pooled estimates are based on a random-effects model. The American Journal of the Medical Sciences 2011 341, 1-9DOI: (10.1097/MAJ.0b013e3181f1fba8) Copyright © 2011 Southern Society for Clinical Investigation Terms and Conditions