ADA AHA ACC一起發表aspirin 對於DM病人CV primary prevention的建議
我們有很多risk evaluation的工具，像framinghan cv risk, UKPDS risk
那10年risk > 10%的人就值得吃，算起來這些人就是：
=>男性>50，女性>60，且有一個額外risk factor(smoking,HTN,dyslipidemia,FHx of premature CVD, albuminuria)
10年risk <5% 不該吃
=> 男性不到50，女性不到60，沒有risk factor
那10年risk 5-10%的
=>可吃可不吃
但是就算三巨頭這麼說，還有兩個study可以提供更好的證據
Aspirin for Primary Prevention in Patients with Diabetes
Recommendations from three professional organizations
The American Heart Association, the American College of Cardiology, and the American Diabetes Association have collaborated to produce a position statement on aspirin for primary prevention in patients with diabetes. The statement includes a meta-analysis of nine randomized trials, in which aspirin lowered risk for coronary events by 9% and for stroke by 15%; neither difference reached statistical significance. The authors estimate that excess risk for gastrointestinal bleeding conferred by aspirin could be as high as 1 to 5 episodes per 1000 diabetic patients annually. Based on their balancing of benefits and harms, the authors make the following recommendations for primary prevention in adults with diabetes:
* Low-dose aspirin (75–162 mg daily) "is reasonable" for patients with 10-year cardiovascular disease (CVD) risk >10% and no risk factors for bleeding. This group would include most diabetic men older than 50 and women older than 60 who have at least one additional major risk factor (i.e., smoking, hypertension, dyslipidemia, family history of premature CVD, or albuminuria).
* Aspirin "should not be recommended" for diabetic men younger than 50 and women younger than 60 with no other risk factors (10-year CVD risk, <5%).
* Aspirin "might be considered" for those at intermediate risk (10-year CVD risk, 5%–10%); this group would include younger patients with, and older patients without, other risk factors.
Several websites with calculators to estimate 10-year cardiovascular risk are listed, including the UKPDS Risk Engine and the ARIC CHD Risk Calculator.
Comment: The authors acknowledge that their recommendations are based on inconclusive evidence: Event rates in randomized trials have been too low to generate precise estimates of aspirin's effect, some estimates are drawn from potentially biased subgroup analyses, and the incremental benefit of aspirin in patients who take statins and other risk-lowering agents is unclear. Ongoing trials that will provide additional data on aspirin prophylaxis include ACCEPT-D (from Italy) and ASCEND (from the U.K.).
— Allan S. Brett, MD
This position statement was published concurrently in Diabetes Care 2010; 33:1395 and J Am Coll Cardiol 2010; 55:2878.
Published in Journal Watch General Medicine July 8, 2010
Citation(s):
Pignone M 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 Jun 22; 121:2694. (http://dx.doi.org/10.1161/CIR.0b013e3181e3b133)
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/fileview?id=0B278nGJMQBk7NmY2NTRjZTUtN2Y1Ni00NWY3LWI2ODAtZmZlMWU1MjVmODUw&hl=zh_TW
http://docs.google.com/present/edit?id=0AW78nGJMQBk7ZGc1d3FjYmpfMjMyZHBjaHN3ZnA&hl=zh_TW
那10年risk > 10%的人就值得吃，算起來這些人就是：
=>男性>50，女性>60，且有一個額外risk factor(smoking,HTN,dyslipidemia,FHx of premature CVD, albuminuria)
10年risk <5% 不該吃
=> 男性不到50，女性不到60，沒有risk factor
那10年risk 5-10%的
=>可吃可不吃
但是就算三巨頭這麼說，還有兩個study可以提供更好的證據
Aspirin for Primary Prevention in Patients with Diabetes
Recommendations from three professional organizations
The American Heart Association, the American College of Cardiology, and the American Diabetes Association have collaborated to produce a position statement on aspirin for primary prevention in patients with diabetes. The statement includes a meta-analysis of nine randomized trials, in which aspirin lowered risk for coronary events by 9% and for stroke by 15%; neither difference reached statistical significance. The authors estimate that excess risk for gastrointestinal bleeding conferred by aspirin could be as high as 1 to 5 episodes per 1000 diabetic patients annually. Based on their balancing of benefits and harms, the authors make the following recommendations for primary prevention in adults with diabetes:
* Low-dose aspirin (75–162 mg daily) "is reasonable" for patients with 10-year cardiovascular disease (CVD) risk >10% and no risk factors for bleeding. This group would include most diabetic men older than 50 and women older than 60 who have at least one additional major risk factor (i.e., smoking, hypertension, dyslipidemia, family history of premature CVD, or albuminuria).
* Aspirin "should not be recommended" for diabetic men younger than 50 and women younger than 60 with no other risk factors (10-year CVD risk, <5%).
* Aspirin "might be considered" for those at intermediate risk (10-year CVD risk, 5%–10%); this group would include younger patients with, and older patients without, other risk factors.
Several websites with calculators to estimate 10-year cardiovascular risk are listed, including the UKPDS Risk Engine and the ARIC CHD Risk Calculator.
Comment: The authors acknowledge that their recommendations are based on inconclusive evidence: Event rates in randomized trials have been too low to generate precise estimates of aspirin's effect, some estimates are drawn from potentially biased subgroup analyses, and the incremental benefit of aspirin in patients who take statins and other risk-lowering agents is unclear. Ongoing trials that will provide additional data on aspirin prophylaxis include ACCEPT-D (from Italy) and ASCEND (from the U.K.).
— Allan S. Brett, MD
This position statement was published concurrently in Diabetes Care 2010; 33:1395 and J Am Coll Cardiol 2010; 55:2878.
Published in Journal Watch General Medicine July 8, 2010
Citation(s):
Pignone M 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 Jun 22; 121:2694. (http://dx.doi.org/10.1161/CIR.0b013e3181e3b133)
* Original article (Subscription may be required)
* Medline abstract (Free)
https://docs.google.com/fileview?id=0B278nGJMQBk7NmY2NTRjZTUtN2Y1Ni00NWY3LWI2ODAtZmZlMWU1MjVmODUw&hl=zh_TW
http://docs.google.com/present/edit?id=0AW78nGJMQBk7ZGc1d3FjYmpfMjMyZHBjaHN3ZnA&hl=zh_TW
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