In a recently published study in the European Heart Journal–Cardiovascular Pharmacotherapy, Olesen et al examined patients with diabetes but without coronary artery disease (CAD) or nonobstructive CAD as assessed by coronary angiography (CAG) from 2003 to 2016 in Western Denmark. The study included 4,124 patients, of whom 2,474 (60%) received aspirin and 2,916 (71%) received statin treatment within 6 months following CAG. The primary study outcome was major adverse cardiovascular (CV) events (MACE), defined as myocardial infarction, ischemic stroke, or all-cause death.

The researchers conducted separate evaluations for rates of CV death, all-cause death, or hospitalization for bleeding associated with aspirin therapy. The average follow-up time was 4.9 years. Patients who received aspirin treatment 6 months after CAG were more likely to be older, and more were female, compared with patients not treated with aspirin. These patients were also more likely to have hypertension and heart failure, and they were treated more frequently with statins, noninsulin diabetes medications, and antihypertensive drugs. Patients in the statin group also were older, and more were female, compared with nontreated patients.

According to the researchers, treatment with statins was more frequently correlated with hypertension, but less frequently associated with heart failure and renal disease. Overall, the 10-year cumulative MACE incidence was comparable in patients treated with aspirin and in nontreated patients (21.3% vs. 21.8%). The researchers also found no difference in 10-year MACE when the average treatment effects of aspirin were estimated with the inverse probability of treatment-weighted hazard ratio ([HRIPTW] 1.01; 95% CI, 0.82-1.25).

The results were comparable for CV death and all-cause death, and hospitalizations for bleeding were not heightened in the aspirin-treated group. Statin treatment following CAG was associated with a 10- year reduced risk for MACE versus nontreated patients (24.6% vs. 37.2%; HRIPTW 0.58; 95% CI, 0.48- 0.70) that was driven by lower risk for myocardial infarction and death. Additionally, the researchers found no considerable effect of high-intensity versus moderate-intensity statin treatment, and among a group of patients undergoing an elective procedure resulting from stable angina pectoris, aspirin did not decrease MACE.

The researchers also noticed a “more modest MACE reduction” associated with statin treatment compared with the main analysis, and a subgroup analysis of patients with type 2 diabetes “yielded comparable results.”

The authors concluded that among patients with diabetes and no obstructive CAD, aspirin neither reduced MACE nor increased bleeding. In contrast, statin treatment was linked to a major reduction in risk of MACE.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

« Click here to return to Cardiology Update.