Quelle place pour l'aspirine en prévention cardiovasculaire primaire chez le diabétique en 2010Â ?

Primary and secondary prevention is essential in patients with type 2 diabetes mellitus to reduce cardiovascular mortality. Atherosclerosis, endothelial dysfunction and impaired platelet function explain the high rate of recurrent atherothrombotic events in this population. According to all guidelines, oral antiplatelet agents, especially aspirin, are the key treatment for secondary prevention but also for primary prevention in high risk patients. However, no prospective study specifically demonstrates the benefit of aspirin in this subgroup. Clopidogrel is slightly more effective than aspirin for secondary prevention but not for primary prevention. A better comprehension of the mechanisms involved, notably aspirin resistance, as well as discovery of new treatments represent new challenges for cardiovascular prevention in this high risk population.