Aspirin of no use in primary prevention of cardiovascular events- POPADAD trial
Nov 1, 2008 - 2:33:34 AM
In the BMJ this week, the results of the POPADAD (the prevention of progression of arterial disease and diabetes)trial were presented. Antiplatelet agents have been known to reduce the risk of secondary cardiovascular events in patients with diabetes and cardiovascular disease and even in peripheral vascular disease. This study was to look at whether antiplatelets would help in the primary prevention of cardiovascular events in patients with diabetes and asymptomatic peripheral vascular disease.
Around 1270 adults with type1 and type 2 diabetes mellitus and with ankle brachial pressure index of 0.99 or less were taken into the study. The participants had no symptomatic cardiovascular disease, aged above 40 years and were from 16 hospitals in Scotland. They were assigned to recieve one of the following- aspirin and placebo, antioxidant and placebo, aspirin and antioxidant, or double placebo.The primary end points were death from coronary artery disease or stroke, non fatal myocardial infarction or stroke and amputation due to critical limb ischemia.
There was no difference in the primary end points in the aspirin vs. non aspirin groups(18.2% vs 18.3%) and no difference between the placebo vs. non placebo group (18.3 vs. 18.2).
There have been previous trials which have shown that aspirin is of no value in the primary prevention of cardiovascular events even in patients who are at high risk. This study helps to give more strength to this point. Perhaps now is the time for a rethink in clinical practice and change in guidelines which recommend the use of aspirin in high risk individuals with no existing cardiovascular disease.
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