Long-term effect of clopidogrel in patients with and without diabetes: A systematic review and meta-analysis of randomized controlled trials

• 作者: Li-Rong Liang Lin Feng Qi Qiu Qian Ma Wen Zheng Wu-Xiang Xie
• 来源期刊: 世界糖尿病杂志:英文版(电子版)
• 学科: 医学
• 关键词: CLOPIDOGREL DIABETES ASPIRIN META-ANALYSIS RANDOMIZED controlled TRIAL
• 年，卷（期）: 2020,（4）
• 页码范围: 137-149
• 页数: 13页
• 分类号: R54

摘要

BACKGROUND Previous studies have shown that patients with diabetes mellitus(DM) respond poorly to clopidogrel treatment.AIM To systematically evaluate the efficacy of clopidogrel for the treatment of acute coronary syndromes or ischemic stroke in patients with or without DM.METHODS Pub Med,the Cochrane Central Register of Controlled Trials,and EMBASE were searched from 1980 on 27 June 2019 to identify relevant randomized controlled trials that compared the effect of a combination of clopidogrel and aspirin with aspirin alone.A random-effects meta-analysis was used to estimate the hazard ratio(HR) and its 95% confidence interval(CI).Sensitivity analysis was performed using a fixed-effect model.The I2 statistic was used to evaluate the heterogeneity of the study data.RESULTS Six randomized controlled trials,comprising 43352 participants(13491 with and 29861 without DM) who had received antiplatelet therapy for≥3 mo,were included in the meta-analysis.Compared with aspirin alone,a combination of clopidogrel and aspirin significantly reduced the risk of any cardiovascular event in patients without DM(HR=0.78,95%CI:0.71–0.86,P<0.001;I2=23%,P=0.26).Clopidogrel plus aspirin also significantly reduced cardiovascular risk in patients with DM,although the effect was smaller(HR=0.89,95%CI:0.81–0.99,P=0.030;I2=0%,P=0.74).Nevertheless,there was no significant difference in the efficacy of clopidogrel at reducing the risk of cardiovascular events in patients with DM vs those without(P for interaction=0.062).CONCLUSION Thus,the present study shows that the addition of clopidogrel to aspirin significantly lowers cardiovascular risk in patients with or without DM who have experienced ischemic cardiovascular disease.The beneficial effect of the addition of clopidogrel to aspirin for patients with DM was lower than that in patients without DM,although the modifying effect of DM did not reach significance.