Journal
DIABETES CARE
Volume 34, Issue 2, Pages 280-285Publisher
AMER DIABETES ASSOC
DOI: 10.2337/dc10-1615
Keywords
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Categories
Funding
- Ministry of Health, Labour and Welfare of Japan
- Astellas Pharma
- AstraZeneca
- Banyu Pharmaceutical Co.
- Bayer
- Baxter
- Boehringer Ingelheim
- Boston Scientific
- Chugai Pharmaceutical Co.
- Daiichi Sankyo Co.
- Dainippon Sumitomo Pharma
- Eisai Pharmaceuticals
- Fukuda Denshi
- Johnson Johnson
- Kirin Pharma
- Kowa Co.
- Kyowa Hakko
- Mochida Pharmaceutical Co.
- Nihon Kohden
- Novartis
- Novo Nordisk
- Ono Pharmaceutical Co.
- Shionogi and Co.
- Taisho Toyama Pharmaceutical Co.
- Pfizer
- sanofi-aventis
- Sanwa Kagaku
- Takeda Pharmaceutical Co.
- Tanabe-Mitsubishi Pharma
- Zeria Pharmaceutical Co.
- Japan Heart Foundation
- Bayer Yakuhin
- Otsuka Pharmaceutical Co.
- Pfizer Japan
- Boehringer lngelheim
- Cathex Co.
- Daiichi Pharmaceutical Corp.
- Dainippon Pharmaceutical Co.
- Get Bros.
- Guidant Japan
- Japan Lifeline Co.
- Kaken Pharmaceutical Co.
- Kissei Pharmaceutical Co.
- Mitsubishi Pharma Corp.
- Mitsubishi Tanabe Pharma
- Nihon Schering
- Pharmacia
- Sankyo Co.
- Sanwa Kagaku Kenkyusho Co.
- Schering-Plough
- Sumitomo Pharmaceuticals Co.
- Tanabe
- Teijin
- Toa Eiyo
- Toni Pharmaceutical Co.
- Toyama Chemical
- Tyco Healthcare Japan
- Vitatron Japan
- Higo Foundation for Promotion of Medical Education and Research
- Japan Foundation of Applied Enzymology
- Japanese Society of Interventional Cardiology
- Kimura Memorial Heart Foundation
- Kumamoto Medical Society
- Smoking Research Foundation
- Takeda Science Foundation
- Nara Medical University
- Megumi Nagahiro (Kumamoto University, Kumamoto, Japan)
- Yoko Wada (Nara Medical University, Kashihara, Japan)
- Tsukimi Higashi (Nara Medical University, Kashihara, Japan)
- Mari Miyagwa (Nara Medical University, Kashihara, Japan)
- Grants-in-Aid for Scientific Research [21590958] Funding Source: KAKEN
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OBJECTIVE-Type 2 diabetes accompanied by renal damage is a strong risk factor for atherosclerotic events. The purpose of this study was to investigate the efficacy of low-dose aspirin therapy on primary prevention of atherosclerotic events in patients with type 2 diabetes and coexisting renal dysfunction. RESEARCH DESIGN AND METHODS-The Japanese Primary Prevention of Atherosclerosis With Aspirin for Diabetes (JPAD) trial was a prospective, randomized, open-label trial conducted throughout Japan that enrolled 2,539 type 2 diabetic patients without a history of atherosclerotic diseases. Patients were assigned to the aspirin group (81 mg/day or 100 mg/day) or the nonaspirin group and followed for a median of 4.37 years. The primary end points were atherosclerotic events of fatal and nonfatal ischemic heart disease, stroke, and peripheral arterial disease. RESULTS-The analysis included 2,523 patients who had serum creatinine measured. In 1,373 patients with baseline estimated glomerular filtration rate (eGFR) 60-89 mL/min/1.73 m(2), the incidence of primary end points was significantly lower in the aspirin group than in the nonaspirin group (aspirin, 30/661; nonaspirin, 55/712; hazard ratio 0.57 [95% CI 0.36-0.88]; P = 0.011). Low-dose aspirin therapy did not reduce primary end points in patients with eGFR >= 90 mL/min/1.73 m(2) (aspirin, 9/248; nonaspirin, 11/270; 0.94 [0.38-2.3]) or those with eGFR <60 mL/min/1.73 m(2) (aspirin, 29/342; nonaspirin, 19/290; 1.3 [0.76-2.4]). The Cox proportional hazard model demonstrated a significant interaction between mild renal dysfunction (eGFR 60 89 mL/min/1.73 m(2)) and aspirin (P = 0.02). CONCLUSIONS-These results suggest a differential effect of low-dose aspirin therapy in diabetic patients with eGFR 60-89 mL/min/1.73 m(2).
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