Low-dose aspirin therapy in patients with type 2 diabetes and reduced glomerular filtration rate: subanalysis from the JPAD trial.
Saito Y,
Morimoto T,
Ogawa H,
Nakayama M,
Uemura S,
Doi N,
Jinnouchi H,
Waki M,
Soejima H,
Sugiyama S,
Okada S,
Akai Y;
Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes Trial Investigators.
Ogawa H, Saito Y, Nakayama M, Kanauchi M, Uemura S, Morimoto T, Masuda I, Nakayama M, Kanauchi M, Ueshima H, Imura H, Kimura K, Morimoto T, Ohtorii M, Miyake E, Mizutani A, Sakamoto K, Jinnouchi H, Hanaoka Y, Waki M, Kawamura K, Shimabukuro M, Nishiura K, Kawano T, Kyoda Y, Hashiguchi J, Kagoshima T, Hanatani M, Matsumura N, Doi N, Nakai K, Kobayashi Y, Suzuki M, Soeda T, Morikawa Y, Horimoto M, Hasegawa A, Yamano S, Matsuo S, Sakamoto Y, Masuda I, Yasuno A, Fujinaga Y, Horii K, Koga T, Ogawa H, Ozaki K, Ikemura M, Hayashi M, Yabuta I, Sughihara K, Yazaki A, Masuda J, Nishitani Y, Naito M, Ote S, Yamada K, Wakabayashi C, Fukuoka Y, Mahara K, Kan H, Oshima E, Sutani T, Hoda K, Sawai K, Yamaga K, Nakamura T, Okamoto S, Horie H, Ashihara K, Miki H, Makino H, Odo T, Iseri Y, Tanaka H, Marutsuka K, Nakatani A, Murakami H, Shioya Y, Horio Y, Ikeda T, Machii K, Kamura M, Ban K, Fujii Y, Nishimoto K, Misugi S, Munakata T, Yoshimura K, Minami S, Nakashima T, Ogata H, Hifumi A, Sakurai N, Tsurusaki R, Yamanaka Y, Yokota H, Ichihara S, Yoshinari M, Sawada Y, Kawashima E, Goto K, Kinoshita Y, Kikukawa M, Yamada H, Tanaka Y, Kiyota M, Kimura Y, Morikami Y, Fukuda M, Takami T, Nakatani F, Naomi S, Nasu T, Sawada T, Minagawa F, Haraguchi O, Kondo N, Shono H, Sugiyama H, Matsuo T, Takaoka M, Nakajima T, Toihata M, Matsuyama K, Komori K, Tsubokura T, Taguchi M, Hiramori Y, Okubo H, Iemura A, Doi O, Ogihara M, Misumi K, Seo K, Iwai K, Naito M, Ozawa S, Minoda K, Fujii H, Miwa K, Egusa G, Yasuda I, Ueda M, Miyata J, Yoshimura M, Uemyama M, Watanabe K, Haraguchi Y, Tanazawa S, Osamura Y, Shibata J, Ono T, Kamijikkoku S, Yoshimoto K, Kinuwaki E, Kozuma K, Onoue K, Nakano Y, Abe N, Araki H, Takaoka K, Imamoto C, Suefuji H, Sugimoto K, Matsunaga T, Oya A, Onishi Y, Kajiwara K, Ikuno T, Doi M, Igaki T, Bando H, Ogura T, Doijiri K, Iwaoka T, Akahoshi K, Obata K, Shimono H, Tsuda K, Yumoto S, Oka K, Hasegawa H, Fujimoto H, Atsumi T, Matsutani A, Katsuyama Y, Fukami R, Iseri Y, Ishibashi Y, Kudou K, Kuwahara T, Maeda K, Maki A, Manda N, Yasue H, Mizuno Y, Momosaki S, Tokube K, Tomita F, Tsuchiya T, Yabuta M, Yamada H.
Source
First Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan. yssaito@naramed-u.ac.jp
Abstract
OBJECTIVE:
Type 2 diabetes accompanied by renal damage is a strong risk factor for atherosclerotic events. The purpose of this study was to investigate the efficacy of low-dose aspirin therapy on primary prevention of atherosclerotic events in patients with type 2 diabetes and coexisting renal dysfunction.
RESEARCH DESIGN AND METHODS:
The Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial was a prospective, randomized, open-label trial conducted throughout Japan that enrolled 2,539 type 2 diabetic patients without a history of atherosclerotic diseases. Patients were assigned to the aspirin group (81 mg/day or 100 mg/day) or the nonaspirin group and followed for a median of 4.37 years. The primary end points were atherosclerotic events of fatal and nonfatal ischemic heart disease, stroke, and peripheral arterial disease.
RESULTS:
The analysis included 2,523 patients who had serum creatinine measured. In 1,373 patients with baseline estimated glomerular filtration rate (eGFR) 60-89 mL/min/1.73 m(2), the incidence of primary end points was significantly lower in the aspirin group than in the nonaspirin group (aspirin, 30/661; nonaspirin, 55/712; hazard ratio 0.57 [95% CI 0.36-0.88]; P = 0.011). Low-dose aspirin therapy did not reduce primary end points in patients with eGFR ≥ 90 mL/min/1.73 m(2) (aspirin, 9/248; nonaspirin, 11/270; 0.94 [0.38-2.3]) or those with eGFR <60 mL/min/1.73 m(2) (aspirin, 29/342; nonaspirin, 19/290; 1.3 [0.76-2.4]). The Cox proportional hazard model demonstrated a significant interaction between mild renal dysfunction (eGFR 60-89 mL/min/1.73 m(2)) and aspirin (P = 0.02).
CONCLUSIONS:
These results suggest a differential effect of low-dose aspirin therapy in diabetic patients with eGFR 60-89 mL/min/1.73 m(2).
- PMID:
- 21270185
- [PubMed - indexed for MEDLINE]
- PMCID:
- PMC3024334
Free PMC ArticleFigure 1
Percentage of primary end points by category of patients with eGFR of at least 90 mL/min/1.73 m2 (A), 60–89 mL/min/1.73 m2 (B), or <60 mL/min/1.73 m2 (C).
Diabetes Care. Diabetes Care;34(2):280-285.
Figure 2
Subgroup analysis of incidence of primary end points.
Diabetes Care. Diabetes Care;34(2):280-285.
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