Prescribing Advice for GPs

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No aspirin mortality benefit in diabetic ACS?

Diabetes Care has published the results of a retrospective analysis of a study examining the treatment of acute coronary syndromes (ACS). This analysis aimed to compare mortality reductions in patients with and without diabetes.

The original study was an observational study involving 2,499 patients admitted to hospital with ACS. 17% (n=425) were diabetic with the majority of parameters being similar between the two groups with the exceptions that patients with diabetes were more likely to be treated with an angiotensin converting enzyme inhibitor (ACEIs) and less likely to be treated with a beta-blocker.

The analysis found that benefits of treatment with ACEIs beta-blockers and statins were comparable but that aspirin was associated with a non-significant mortality reduction in patients with diabetes and clopidogrel was associated with a non-significant mortality reduction in both groups.

The number of patients taking clopidogrel is likely to have been low and therefore the results are not discussed further but more weight is given to the difference seen in the aspirin data by the authors. However, this is a secondary analysis of an observational study involving a small number of patients and as such the findings should be viewed with caution and used to generate further clinical trials.

It remains unclear if low-dose aspirin is of any benefit to a diabetic patient with ACS, whether higher doses could confer greater benefits or whether alternative agents or combinations should replace aspirin.

Action: Clinicians should continue with current practice following episodes of ACS until further work confirms the best course of action for diabetic patients with ACS.

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