Response to Comment on: DiChiara et al. (2007) The Effect of Aspirin Dosing on Platelet Function in Diabetic and Nondiabetic Patients: An Analysis From the Aspirin-Induced Platelet Effect (ASPECT) Study: <i>Diabetes</i> 56:3014–3019, 2007

DiChiara, Joseph; Bliden, Kevin P.; Tantry, Udaya S.; Hamed, Miruais S; Antonino, Mark J.; Suarez, Thomas; Bailon, Oscar; Singla, Anand; Gurbel, Paul A.

doi:10.2337/db08-0250

Cited by 5 publications

(5 citation statements)

References 2 publications

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“…57 More importantly, these dose-dependent effects were more pronounced in patients with diabetes, where treatment with higher doses was found to be effective in inhibiting platelet function. 58 Similar results reporting a low prevalence of aspirin resistance using COX-1-specific assays have been reported. 59 At the same time, further studies have found a correlation between adverse clinical events and aspirin resistance, as measured by PFA-100.…”

Section: Aspirin Resistance Is Assay-specificsupporting

confidence: 74%

Antiplatelet Resistance—Fact or Myth?

Gurbel

Tantry

2009

The American Heart Hospital Journal

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Section: Aspirin Resistance Is Assay-specificsupporting

confidence: 74%

Antiplatelet Resistance—Fact or Myth?

Gurbel

Tantry

2009

The American Heart Hospital Journal

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“…These pathological mechanisms are not influenced by antiplatelet drugs, which may explain the lack of a protective effect of aspirin against ASCVD in this study population. Moreover, although patients with diabetes treated with low-dose aspirin exhibit aspirin resistance, higher doses can partially overcome the resistance 28 . Higher doses of aspirin may be necessary to prevent ASCVD in this study population.…”

Section: Discussionmentioning

confidence: 99%

Low‐dose aspirin for prevention of cardiovascular mortality in patients with type 2 diabetes and chronic kidney disease: A real‐world nationwide cohort study

Lin,

Chen,

Chen

et al. 2023

J of Diabetes Invest

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Aims/IntroductionCardiovascular mortality risk is elevated among patients with diabetes and concurrent chronic kidney disease. However, controversy surrounds the use of aspirin for primary prevention within this population. This study aims to assess the effectiveness and safety of low‐dose aspirin for primary prevention in patients with diabetes and pre‐end‐stage renal disease.Materials and MethodsThis was a retrospective population‐based cohort study using the National Health Insurance Research Database in Taiwan. The study included adults with type 2 diabetes who were enrolled in the pre‐end‐stage renal disease pay‐for‐performance program and had no atherosclerotic cardiovascular disease. We used propensity score analysis to control baseline characteristics between the two groups. Clinical outcomes including cardiovascular mortality, all‐cause mortality, major bleeding, and renal disease progression were compared between patients who first received aspirin and those who did not.ResultsBetween January 2012 and December 2015, a total of 2,155 low‐dose aspirin users and 6,737 nonaspirin users were identified. Following propensity score adjustment, aspirin use exhibited a comparable risk of cardiovascular death compared with nonaspirin users (adjusted hazard ratio [aHR] 1.12; 95% confidence interval [CI] 0.65–1.95; P = 0.681). The risk of all‐cause mortality was similar between the two groups (aHR 1.07; 95% CI 0.92–1.24; P = 0.385). Similar risks were observed in terms of major bleeding and renal disease progression.ConclusionsIn patients with diabetes and pre‐end‐stage renal disease who lacked atherosclerotic cardiovascular disease, low‐dose aspirin did not demonstrate a reduction in mortality. These findings do not support the use of aspirin for primary prevention in this high‐risk population.

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“…In contrast, higher doses (≥325 mg) of aspirin showed a reverse interaction with weight, reducing CV events only at larger body size and increased weights. Further confounding the results of many studies, both obesity and diabetes may affect an individual’s response to aspirin, 22–24 and the enteric-coat of some aspirin formulations, which reduces gastrointestinal protection and impairs consistent absorption of the drug. 25–27…”

Section: Strategies and Evidencementioning

confidence: 99%

Aspirin for the Primary Prevention of Cardiovascular Disease: Time for a Platelet-Guided Approach

Cofer

Barrett

2022

ATVB

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Aspirin protects against atherothrombosis while increasing the risk of major bleeding. Although it is widely used to prevent cardiovascular disease (CVD), its benefit does not outweigh its risk for primary CVD prevention in large population settings. The recent United States Preventive Services Task Force guidelines on aspirin use to prevent CVD reflect this clinical tradeoff as well as the persistent struggle to define a population that would benefit from prophylactic aspirin therapy. Past clinical trials of primary CVD prevention with aspirin have not included consideration of a biomarker relevant to aspirin’s mechanism of action, platelet inhibition. This approach is at odds with the paradigm used in other key areas of pharmacological CVD prevention, including antihypertensive and statin therapy, which combine cardiovascular risk assessment with the measurement of mechanistic biomarkers (eg, blood pressure and LDL [low-density lipoprotein]-cholesterol). Reliable methods for quantifying platelet activity, including light transmission aggregometry and platelet transcriptomics, exist and should be considered to identify individuals at elevated cardiovascular risk due to a hyperreactive platelet phenotype. Therefore, we propose a new, platelet-guided approach to the study of prophylactic aspirin therapy. We think that this new approach will reveal a population with hyperreactive platelets who will benefit most from primary CVD prevention with aspirin and usher in a new era of precision-guided antiplatelet therapy.

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Response to Comment on: DiChiara et al. (2007) The Effect of Aspirin Dosing on Platelet Function in Diabetic and Nondiabetic Patients: An Analysis From the Aspirin-Induced Platelet Effect (ASPECT) Study: Diabetes 56:3014–3019, 2007

Cited by 5 publications

References 2 publications

Antiplatelet Resistance—Fact or Myth?

Antiplatelet Resistance—Fact or Myth?

Low‐dose aspirin for prevention of cardiovascular mortality in patients with type 2 diabetes and chronic kidney disease: A real‐world nationwide cohort study

Aspirin for the Primary Prevention of Cardiovascular Disease: Time for a Platelet-Guided Approach

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