Use of aspirin to reduce risks of cardiovascular disease in patients with diabetes: clinical and research challenges

Non-steroidal anti-inflammatory drugs and risk of Parkinson's disease in the elderly population: a meta-analysis

PURPOSE

Several studies have explored the impact of non-steroidal anti-inflammatory drugs (NSAIDs) and the risk of Parkinson disease (PD). However, the extent to which NSAIDs may increase or decrease the risk of PD remains unresolved. We, therefore, performed a meta-analysis of relevant studies to quantify the magnitude of the association between NSAID use and PD risk in the elderly population.

METHODS

The electronic databases such as PubMed, EMBASE, Scopus, Google Scholar, and Web of Science were used to search the relevant articles published between January 1990 and December 2017. Large (n ≥ 1000) observational design studies with a follow-up at least 1 year were considered. Two authors independently extracted information from the included studies. Random effect model was used to calculate risk ratios (RRs) with 95% confidence interval (Cl).

RESULTS

A total of 17 studies with 2,498,258 participants and nearly 14,713 PD patients were included in the final analysis. The overall pooled RR of PD was 0.95 (95%CI 0.860-1.048) with significant heterogeneity (I² = 63.093, Q = 43.352, p < 0.0001). In the subgroup analysis, the overall pooled RR of PD was 0.90 (95%CI 0.738-1.109), 0.96 (95%CI 0.882-1.055), and 0.99 (95%CI 0.841-0.982) from the studies of North America, Europe, and Asia. Additionally, long-term use, study design, individual NSAID use, and risk of PD were also evaluated.

CONCLUSION

Despite the neuroprotective potential of NSAIDs demonstrated in some experimental studies, our findings suggest that there is no association between NSAIDs and the risk of Parkinson disease at the population level. Until further evidence is established, clinicians need to be vigilant ensuring that the use of NSAIDs remains restricted to their approved anti-inflammatory and analgesic effect.

Telemedicine cardiovascular risk reduction in veterans

BACKGROUND

Patients with co-occurrence of hypertension, hyperlipidemia, and diabetes have an increased risk of cardiovascular disease (CVD) events. Comprehensive programs addressing both tailored patient self-management and pharmacotherapy are needed to address barriers to optimal cardiovascular risk reduction. We are examining a Clinical pharmacy specialist-, telephone-administered intervention, relying on home monitoring, with a goal of providing tailored medication and behavioral intervention to Veterans with CVD risk.

METHODS

Randomized controlled trial including patients with hypertension (blood pressure >150/100 mm Hg) or elevated low density liporotein (>130 mg/dL). Longitudinal changes in CVD risk profile and improvement in health behaviors over time will be examined.

CONCLUSION

Given the national prevalence of CVD and the dismal rates of risk factor control, intensive but easily disseminated interventions are required to treat this epidemic. This study will be an important step in testing the effectiveness of a behavioral and medication intervention to improve CVD control among Veterans.

Gender-specific care of diabetes

Diabetic men have benefited in the last 30 years from a significant improvement in total and cardiovascular mortality, whereas diabetic women have had no improvement at all. Moreover, recent research focused on the role of sex hormones in glucose homeostasis, and might account for different pathophysiologic mechanisms in the development of diabetes-related complications. Thus, care of diabetic women is a challenge that requires particular attention. The available data regarding gender-specific care of diabetes mellitus are uneven, rich in some domains but very poor in others. The large prospective trials performed in the last 20 years have assumed that the natural history of diabetes mellitus in men and women, as well as the efficiency of glucose-lowering therapies and management of hyperglycemic-related complications, could be attributable without distinction to men and women. We propose in this paper to analyze the published medical literature according to the specific management of diabetes mellitus in women, and to try to distinguish some particular features. We found important distinctions between diabetic men and women regarding the patterns of abnormalities of glucose regulation, epidemiology, development of diabetes-related complications, ischemic heart disease, morbidity and mortality, impact of cardiovascular risk factors, development of the metabolic syndrome, depression and osteoporosis, as well as the impact of lifestyle modifications or primary and secondary preventions on cardiovascular risk factors, and finally medical therapeutics. Moreover, special considerations were given to some particular aspects of the medical life in diabetic women, such as the features of gestational diabetes mellitus and the management of pregnancy in pregestational diabetic women, use of contraception, hormone-replacement therapy and polycystic ovary syndrome.

The consultant pharmacist provides consultation and recommendations for a medical patient

This case focuses on a general medical patient who resides in a local senior community-housing center and who has multiple comorbid diseases that are commonly seen in practice. The patient's past medical history includes coronary artery disease, peptic ulcer disease, hypertension, and type 2 diabetes mellitus. The patient was recently hospitalized and treated with an intravenous antibiotic for an influenza-related pneumonia infection, then discharged with a prescription for a course of oral fluoroquinolone antibiotics. This case discusses and addresses each of the patient's conditions, various drug interactions, and issues pertaining to the patient. An interdisciplinary-team approach is important for the medical management of a patient with multiple comorbid diseases along with the contribution of a consultant pharmacist as pharmacotherapy expert.

Long-term effects of cilostazol on the prevention of macrovascular disease in patients with type 2 diabetes mellitus

We analyzed the medical records of 884 type 2 DM patients who were taking different antiplatelet agents for more than 2 years. Based on the records, occurrences of cardiovascular events for 10 years were evaluated. The composite disease-free survival rate for cilostazol monotherapy group was similar to aspirin subgroup (p=0.133).

Gender-specific care of diabetes mellitus: particular considerations in the management of diabetic women

In the past 30 years, the all-cause mortality and cardiovascular mortality rates for women with diabetes mellitus (DM), in contrast to men, have not declined. Furthermore, the difference between all-cause mortality rates in women with DM and those without DM has more than doubled. This urgently needs addressing. This review will analyse published medical literature relating to the specific management of DM in women and try to identify areas where gender affects care. We have identified specific gender differences in the pathophysiology of glucose homeostasis disorder, diabetes-related complications and any female gender-specific features of women with diabetes, such as contraception and the menopause. These gender-specific features of DM may offer a route to improved care for women and new therapeutic possibilities.

The Role of Aspirin in Cardiovascular Disease Prevention in Women

Cardiovascular disease is the nation's number one killer of women. Through its actions on platelet inhibition, aspirin is an effective agent for primary and secondary cardiovascular disease prevention and for use with cardiac interventions. However, the evidence for aspirin's effectiveness in women differs by age and indication compared to men. As primary prevention, low dose aspirin is recommended for women over age 65 to reduce the risk of myocardial infarction and stroke while younger women at high risk for stroke may benefit from aspirin. Aspirin has benefits in other selected patient groups, including diabetics and patients presenting with ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction acute coronary syndrome (NSTEMI/ACS), peripheral arterial disease, stroke, coronary artery bypass graft (CABG), and percutaneous coronary intervention (PCI). Alternative platelet therapy using dipyridamole or clopidogrel, alone or with aspirin, provides some improved efficacy for reduction in recurrent events for NSTEMI, ASC and PCI, although bleeding risks may be greater. However, dual antiplatelet therapy is not currently recommended for primary prevention in even high risk subjects. Despite the evidence base and guidelines, the use of aspirin in women remains suboptimal and warrants improved provider and patient awareness.

Diabetic neuropathy: mechanisms to management

Neuropathy is the most common and debilitating complication of diabetes and results in pain, decreased motility, and amputation. Diabetic neuropathy encompasses a variety of forms whose impact ranges from discomfort to death. Hyperglycemia induces oxidative stress in diabetic neurons and results in activation of multiple biochemical pathways. These activated pathways are a major source of damage and are potential therapeutic targets in diabetic neuropathy. Though therapies are available to alleviate the symptoms of diabetic neuropathy, few options are available to eliminate the root causes. The immense physical, psychological, and economic cost of diabetic neuropathy underscore the need for causally targeted therapies. This review covers the pathology, epidemiology, biochemical pathways, and prevention of diabetic neuropathy, as well as discusses current symptomatic and causal therapies and novel approaches to identify therapeutic targets.

Effect of chronic aspirin administration on an experimental model of metabolic syndrome

1. The aim of the present study was to examine the effect of chronic administration of aspirin on metabolic and cardiovascular parameters in fructose-fed rats (FFR), an experimental model of metabolic syndrome. 2. Chronic treatment of FFR with aspirin (10 mg/kg per day for 6 weeks) partially reversed the increment in systolic blood pressure. In addition, chronic aspirin treatment normalized relative heart weight and vascular remodelling of renal and carotid arteries, measured as lumen diameter: medial thickness ratio. 3. Furthermore, chronic aspirin administration completely reversed glucose intolerance and decreased the oxidative status that characterizes the FFR model, as indicated by decreased plasma levels of thiobarbituric acid-reactive substances and aortic NAD(P)H oxidase activity. 4. Prevention of oxidative stress and vascular remodelling in FFR may contribute to the protective actions attributed to aspirin in the treatment of metabolic syndrome.

Review: Aspirin and Diabetes Mellitus: revisiting an old player

Type 2 Diabetes Mellitus confers an excess risk of cardiovascular disease. The mechanisms involved in the development of the disease are an active field of research, and prompt the development of newer and safer therapeutics with implications for cardiovascular disease. Currently there is increasing awareness of the role of platelet dysfunction, low-grade chronic inflammation and thrombogenesis in the pathophysiology of insulin resistance, T2DM, as well as type 1 diabetes mellitus and cardiovascular disease. This new evolving knowledge has allowed a better understanding of the role of aspirin, an old medication with proven beneficial effects on patients with established cardiovascular disease. The influence of salicylates on insulin resistance, glucose homeostasis, platelet function and inflammatory pathways, in particular related to the activation of the NF κB pathway, is a promising field of active research, and will help in the management of both diabetes mellitus and atherosclerotic-related cardiovascular disease.

Use of aspirin for primary and secondary prevention of cardiovascular disease in diabetic patients in an ambulatory care setting in Spain

BACKGROUND

This study was conducted in order to determine the use of aspirin and to assess the achievement of therapeutic targets in diabetic patients according to primary (PP) or secondary prevention (SP).

METHODS

This is a retrospective, observational study including patients > or =18 years with diabetes mellitus followed in four primary care centers. Measurements included demographics, use of aspirin and/or anticoagulant drugs, co-morbidities, clinical parameters and proportion of patient at therapeutic target (TT). Descriptive statistics, chi-square test and logistic regression model were used for significance.

RESULTS

A total of 4,140 patients were analyzed, 79.1% (95% confidence intervals [CI]: 77.7-80.5%) in PP and 20.9% (95% CI: 18.2-23.7%) in SP. Mean age was 64.1 (13.8) years, and 49.3% of patient were men (PP: 46.3, SP: 60.7, p = 0.001). Aspirin was prescribed routinely in 20.8% (95% CI: 19.4-22.2%) in PP and 60.8% (95% CI: 57.6-64.0%) in SP. Proportion of patient at TT was 48.0% for blood pressure and 59.8% for cholesterol. Use of aspirin was associated to increased age [OR = 1.01 (95% CI: 1.00-1.02); p = 0.011], cardiovascular-risk factors [OR = 1.14 (95% CI: 1.03-1.27); p = 0.013], LDL-C [OR = 1.42 (95% CI: 1.06-1.88); p = 0.017] and higher glycated hemoglobin [OR = 1.51 (95% CI: 1.22-1.89); p = 0.000] were covariates associated to the use of aspirin in PP.

CONCLUSION

Treatment with aspirin is underused for PP in patients with diabetes mellitus in Primary Care. Achievement of TT should be improved.