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Aspirin in a diabetic retinopathy setting: Insights from NO BLIND study
Pia Clara Pafundi1, Raffaele Galiero1, Alfredo Caturano1
1University of Campania "Luigi Vanvitelli", Department of Advanced Medical and Surgical Sciences, Piazza Luigi Miraglia 2, 80138, Naples, Italy.
Insights
Aspirin use in type 2 diabetes patients was not linked to diabetic retinopathy (DR) after accounting for other health factors. Individual patient needs should guide aspirin therapy, even when using telemedicine.
Area of Science:
- Ophthalmology
- Endocrinology
- Cardiology
Background:
- Diabetic retinopathy (DR) is a common diabetes complication, often linked to cardiovascular (CV) diseases.
- Aspirin is widely used for CV prevention in diabetic patients.
- The effect of aspirin on DR remains debated.
Purpose of the Study:
- To investigate the association between aspirin therapy and diabetic retinopathy in type 2 diabetes patients.
- To assess this relationship in a cohort screened via telemedicine.
Main Methods:
- A cross-sectional, multicenter observational study (NO Blind) involving 2068 type 2 diabetes patients.
- Patients were divided into groups with and without DR.
- Statistical analysis adjusted for confounders like age, gender, MACEs, and eGFR.
Main Results:
- Initially, aspirin showed a significant association with DR and proliferative DR (PDR).
- However, this association was lost after adjusting for major adverse cardiovascular events (MACEs) and estimated glomerular filtration rate (eGFR).
- Aspirin was not associated with DR after comprehensive adjustment for cardio-metabolic confounders.
Conclusions:
- Aspirin therapy is not associated with diabetic retinopathy in type 2 diabetes patients when adjusted for key cardio-metabolic factors.
- The pro-hemorrhagic effects of aspirin warrant individualized treatment decisions.
- Telemedicine can aid in tailoring aspirin use for diabetic patients.
Background And Aims:
Diabetic retinopathy (DR) is the most common microvascular complication of diabetes. Diabetic macroangiopathies, particularly cardiovascular (CV) diseases, seem closely related to diabetes microvascular complications. Aspirin represents the most prescribed compound in CV prevention. Aspirin impact on DR is still object of debate. As it is already recommended among diabetics at high CV risk, aim of this study was to assess a potential relationship between DR and aspirin therapy, in a type 2 diabetes cohort of patients screened through telemedicine.
Methods And Results:
NO Blind is a cross-sectional, multicenter, observational study, which involved nine Italian outpatient clinics. Primary endpoint was the assessment of the relationship between aspirin treatment and DR. 2068 patients were enrolled in the study, subsequently split in two subpopulations according to either the presence or absence of DR. Overall, 995 subjects were under aspirin therapy. After adjusting for most common potential confounders, age and gender, aspirin reveals significantly associated with DR (OR: 1.72, 95%CI: 1.58-2.89, p = 0.002) and proliferative DR (PDR) (OR: 1.89, 95%CI: 1.24-2.84, p = 0.003). Association comes lost further adjusting for MACEs (OR: 1.28, 95%CI: 0.85-1.42, p = 0.157) (Model 4) and eGFR (OR: 0.93; 95%CI: 0.71-1.22; p = 0.591) (Model 5).
Conclusion:
In this multicenter cross-sectional study including a large sample of outpatients with T2DM, we showed that aspirin was not associated with DR after adjustment for several cardio-metabolic confounders. However, as partially confirmed by our findings, and related to the well-known pro-hemorrhagic effect of aspirin, its use should be individually tailored, even by telemedicine tools.
