Takeshi Morimoto1; Hisao Ogawa2; Masafumi Nakayama2; Shiro Uemura3; Masao Kanauchi3; Naofumi Doi3; Hideaki Jinnouchi4; Hirofumi Soejima5; Seigo Sugiyama5; Masako Waki6; Takahiro Kawano7; Yoshihiko Saito8， Japanese Primary Prevention of Atherosclerosis with Aspirin for Diabetes (JPAD) Trial Investigators
　　1 Kyoto Univ Graduate Sch of Medicine， Kyoto， Japan
　　2 Graduate Sch of Med Sciences， Kumamoto Univ， Kumamoto， Japan
　　3 Nara Med Univ， Nara， Japan
　　4 Jinnouchi Clinic Diabetes Care Cntr， Kumamoto， Japan
　　5 Graduate Sch of Med Sciences， Kumamoto Univ， Kumamoto， Japan
　　6 Shizuoka City Shizuoka Hosp， Shizuoka， Japan
　　7 Oyodo Hosp， Yoshino， Japan
　　8 Nara Med Univ， Nara， Japan
　　Objectives: Hyperlipidemia frequently coexists with type 2 diabetes and statin and low-dose aspirin are treatment options to reduce the risk of atherosclerotic events， but appropriate candidate for such treatment is unclear. To explore the treatment strategies， we analyzed the impact of statin and aspirin use on atherosclerotic events in type 2 diabetic patients.
　　Methods: JPAD trial was a randomized， controlled， open-label blinded-endpoint study to examine the efficacy of low-dose aspirin therapy for primary prevention of atherosclerotic events. It enrolled 2539 patients with a median follow-up of 4.4 years， and statins were prescribed by physicians based on clinical judgment.
　　Results: 1345 (53%) patients had history of hypercholesteremia and 650 (26%) took statin at baseline. 154 atherosclerotic events occurred: 68/1262 in the aspirin group and 86/1277 in the non-aspirin group (Hazard Ratio [HR]， 0.83; 95%CI， 0.58 –1.10); 35/650 in the statin group and 119/1889 in the non-statin group (HR， 0.83; 95%CI， 0.56 –1.20). Aspirin was significantly associated with lower atherosclerotic events in non-statin group (HR， 0.69; 95% CI， 0.48 – 0.99). Those without both drugs were higher risk of atherosclerotic events than those with at least one drug among 1693 patients with LDL100 mg/dL (Figure).
　　Conclusion: Either aspirin or statin use was shown to reduce risk of atherosclerotic events in type 2 diabetic patients with increased LDL.
　　Figure. Cumulative incidence of atherosclerotic events according to aspirin and statin use in patients with LDL100 mg/dL