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1+ In primary prevention, aspirin benefit depends on the baseline cardiovascular risk (178).
In a meta-analysis on the effectiveness of aspirin in primary prevention (184), no statistically
significant differences were found in cardiovascular morbidity in the subgroup of
diabetic patients.
1+ Two subsequent RCTs in primary prevention (180; 186) show contradictory results in
the subgroup of diabetic patients. Only a study carried out across women (186) offered
favourable results in the reduction of stroke, though no differences were observed in
coronary disease nor in cardiovascular events as a whole.
1+ Aspirin increases the bleeding risk among the diabetic population (178; 180; 184; 186).
1+ In diabetic patients with microalbuminuria, an RCT observed that an intensive treatment
with habit changes, strict glycemic control and aggressive pharmacological treatment
(which included aspirin and statins) reduced cardiovascular morbimortality (180).
1++ Statins reduce coronary (188) and cardiovascular events (190). Atorvastatin at 10 mg
doses is effective to reduce cardiovascular events in primary prevention in type 2 diabetic
patients with no prior cardiovascular disease, with LDL-cholesterol below 160 mg/
dl and with an additional risk factor (equivalent to a moderate coronary risk): high blood
pressure, retinopathy, micro-or macroalbuminuria or smoking (190).
1+ In an RCT carried out with fenofibrate in DM 2 patients in primary and secondary prevention
with low HDL–c levels and slightly high triglycerides, no differences were observed
in the study’s main variable (coronary mortality and non-fatal AMI) nor in the
overall survival, though there were differences in a secondary variable of total cardiovascular
events (especially at the expense of revascularization procedures) (189).
Recommendations
D
C
C
C
The located evidence does not permit the provision of a recommendation in favour of
ischemic cardiopathy screening among the general asymptomatic diabetic population.
More studies are required in selected high-risk population groups.
The same measures are not recommended when treating the general diabetic population
and the population group which has suffered an AMI.
When the use of a risk table is required to calculate coronary risk in diabetic patients, the
tables of the REGICOR project are recommended.
Diabetic patients with more than 15 years of evolution, and in particular if they are
women, should consider a treatment with statins, due to its high cardiovascular risk.
B A treatment with statins is recommended for diabetic patients with coronary risk ³10%
according to the REGICOR table.
D A treatment with aspirin can be considered for diabetic patients with coronary risk ³10%
according to the REGICOR table.
B
In type 2 diabetic patients with cardiovascular risk ³10% in the REGICOR table and for
whom statins are contraindicated or not tolerated, the administration of fibrates can be
considered.
CLINICAL PRACTICE GUIDELINE ON TYPE 2 DIABETES 81