(JAMA. 2008;300 : 2134-2141. Available pre-embargo to the media at www.jamamedia.org.)
Editor's Note: This study was supported by the Ministry of Health, Labour and Welfare of Japan. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
Editorial: Aspirin For Primary Prevention Still an Open Question for Patients with Diabetes
"The use of aspirin for primary prevention of cardiovascular events in individuals with diabetes is widely recommended by existing guidelines, but the evidence supporting its efficacy is surprisingly scarce," writes Antonio Nicolucci, M.D., from Consorzio Mario Negri Sud, Italy, in an accompanying editorial.
"The lack of precision and the low statistical power in the JPAD trial are the consequence of the substantially lower than expected event rate in the trial population." Dr. Nicolucci writes that the study population had a very low baseline risk of cardiovascular events and questions whether the results can be generalized to other populations with substantially higher cardiovascular risks.
"The issue of aspirin therapy for patients with diabetes is an example of how, in the presence of a long-lasting uncertainty, scientific organizations or governmental bodies should provide the foundation for answering this question by promoting pragmatic, large-scale clinical trials. Considering all diabetic patients with no history of cardiovascular disease (except those with documented contraindications or perceived indications) as candidates for randomized clinical trials would represent a major contribution to the credibility of scientific methods in guiding practice."