臨床研究と生命倫理ジャーナル

概要

Aspirin and Diabetes Care in Nigeria: Treatment or Exploitation?

Cardiovascular disorders have become leading drivers of untimely deaths almost everywhere. Such deaths are however declining globally due to effective interventions. Low dose aspirin contributes to this reduction when used appropriately through minimization of the risk of coronary heart disease and other occlusive atherosclerotic syndromes that can complicate type 2 diabetes/or hypertension. One local study published in 2004 indicated that aspirin was prescribed for 33% of patients with type 2 diabetes. Since then, aspirin prescription, as part of standard therapy for type 2 diabetes/or hypertension, has risen steadily with some studies reporting this to be 66%-88%; These figures more than double those reported in jurisdictions overseas where occlusive atherosclerotic disorders commonly complicate type 2 diabetes and/or hypertension. Even so, recent transnational data show that cardiovascular deaths linked to type 2 diabetes and or hypertension are not abating in sub-Saharan Africa as in many other regions. This can suggest that interventions in black Africa, if any, maybe less than effective in comparison to areas where health outcomes are improving. Significantly, type 2 diabetes and/or hypertension can behave differently in many black groups within Africa such that occlusive atherosclerotic disorders are less common health consequences even with rising cholesterol levels. In the case of Nigeria, the evidence of cardiovascular health benefits of aspirin, as extensively described in groups overseas, appears hard to find for local cohorts. Indeed what the available data strongly suggest is that effective control of blood pressure is a higher treatment priority for saving Nigerian lives than interventions aimed at retarding the atherosclerotic process. Given these observations, the question ought to be asked whether or not low dose aspirin in type 2 diabetes/hypertension therapies, as locally practiced, is the best way of optimizing limited resources in saving Nigerian lives. This paper examines the evidence.