Aspirin Recommended as Preventive for Cardiovascular Events in Diabetics
Low-dose aspirin (75 to 162 mg/day) is a "reasonable" choice for adults with diabetes who have a 10-year risk for cardiovascular disease above 10% and are not at increased risk for bleeding, according to a statement from the American Diabetes Association, the American Heart Association, and the American College of Cardiology.
The statement, published in Circulation, is based on meta-analysis of nine trials examining the effects of aspirin to prevent cardiovascular disease events in patients with diabetes. It also recommends the following:
Adults with diabetes who are at increased risk for cardiovascular disease (e.g., men over 50 or women over 60 with an additional CVD risk factor) should receive aspirin for primary prevention.
Patients at intermediate risk for cardiovascular disease (e.g., younger patients with at least one risk factor, older patients with no risk factors, or patients with a 10-year risk of 5% to 10%) may consider taking daily aspirin.
Wednesday, June 2, 2010
CREST Trial Points to Endarterectomy as Preferred Stroke Preventive Strategy
A comparison of endarterectomy versus stenting in treating carotid artery stenosis shows that stent recipients are at higher risk for stroke within 30 days of the procedure, according to a New England Journal of Medicine study released online.
Investigators in the CREST trial randomized some 2500 patients with carotid artery stenosis to either stenting or endarterectomy. After a median follow-up of 2.5 years, the groups showed no significant difference in the primary endpoint — a composite of stroke, myocardial infarction, or death from any cause during the periprocedural period, or ipsilateral stroke within 4 years.
However, the 4-year rate of stroke or death significantly favored endarterectomy. When the individual outcomes were examined, there were significantly more periprocedural strokes after stenting, and more MIs after endarterectomy.
Editorialists conclude that "endarterectomy remains the preferred treatment for most patients."
Investigators in the CREST trial randomized some 2500 patients with carotid artery stenosis to either stenting or endarterectomy. After a median follow-up of 2.5 years, the groups showed no significant difference in the primary endpoint — a composite of stroke, myocardial infarction, or death from any cause during the periprocedural period, or ipsilateral stroke within 4 years.
However, the 4-year rate of stroke or death significantly favored endarterectomy. When the individual outcomes were examined, there were significantly more periprocedural strokes after stenting, and more MIs after endarterectomy.
Editorialists conclude that "endarterectomy remains the preferred treatment for most patients."
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