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A Randomized Controlled Trial

Hisao Ogawa, MD, PhD; Masafumi Nakayama, MD, PhD; Takeshi Morimoto, MD, PhD; Shiro Uemura, MD, PhD; Masao Kanauchi, MD, PhD; Naofumi Doi, MD, PhD; Hideaki Jinnouchi, MD, PhD; Seigo Sugiyama, MD, PhD; Yoshihiko Saito, MD, PhD; for the Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) Trial Investigators

JAMA. 2008;300(18):2134-2141. Published online November 9, 2008 (doi: 10.1001/jama.2008.623).

Context  Previous trials have investigated the effects of low-dose aspirin on primary prevention of cardiovascular events, but not in patients with type 2 diabetes.

Objective  To examine the efficacy of low-dose aspirin for the primary prevention of atherosclerotic events in patients with type 2 diabetes.

Design, Setting, and Participants  Multicenter, prospective, randomized, open-label, blinded, end-point trial conducted from December 2002 through April 2008 at 163 institutions throughout Japan, which enrolled 2539 patients with type 2 diabetes without a history of atherosclerotic disease and had a median follow-up of 4.37 years.

Interventions  Patients were assigned to the low-dose aspirin group (81 or 100 mg per day) or the nonaspirin group.

Main Outcome Measures  Primary end points were atherosclerotic events, including fatal or nonfatal ischemic heart disease, fatal or nonfatal stroke, and peripheral arterial disease. Secondary end points included each primary end point and combinations of primary end points as well as death from any cause.

Results  A total of 154 atherosclerotic events occurred: 68 in the aspirin group (13.6 per 1000 person-years) and 86 in the nonaspirin group (17.0 per 1000 person-years) (hazard ratio [HR], 0.80; 95% confidence interval [CI], 0.58-1.10; log-rank test, P = .16). The combined end point of fatal coronary events and fatal cerebrovascular events occurred in 1 patient (stroke) in the aspirin group and 10 patients (5 fatal myocardial infarctions and 5 fatal strokes) in the nonaspirin group (HR, 0.10; 95% CI, 0.01-0.79; P = .0037). A total of 34 patients in the aspirin group and 38 patients in the nonaspirin group died from any cause (HR, 0.90; 95% CI, 0.57-1.14; log-rank test, P = .67). The composite of hemorrhagic stroke and significant gastrointestinal bleeding was not significantly different between the aspirin and nonaspirin groups.

Conclusion  In this study of patients with type 2 diabetes, low-dose aspirin as primary prevention did not reduce the risk of cardiovascular events.

Trial Registration  clinicaltrials.gov Identifier: NCT00110448

Author Affiliations: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (Drs Ogawa, Nakayama, and Sugiyama); Center for Medical Education, Kyoto University Graduate School of Medicine, Kyoto, Japan (Dr Morimoto); First Department of Internal Medicine, Nara Medical University, Nara, Japan (Drs Uemura, Kanauchi, Doi, and Saito); and Jinnouchi Hospital, Kumamoto (Dr Jinnouchi).

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