Key result
In Chinese patients with type 2 diabetes, low-dose aspirin use was associated with a paradoxical increased risk of cardiovascular events in primary prevention (HR 2.07) and no benefit in secondary prevention.
Why the study?
Does low-dose aspirin reduce cardiovascular events in type 2 diabetic patients?
Cohort (n=6,454)
Does low-dose aspirin reduce cardiovascular events in type 2 diabetic patients?
Hazard Ratio: 2.07 (95% CI 1.66–2.59)
Absolute Event Rate: 13.3% vs 5.5%
p-value: p=< 0.001
In Chinese type 2 diabetic patients, low-dose aspirin therapy was associated with a paradoxical increase in cardiovascular risk for primary prevention and no benefit for secondary prevention, while significantly increasing the risk of gastrointestinal bleeding.
Caution advised against routine low-dose aspirin in Chinese T2D; observational data leaves open confirmation via targeted RCTs.
BACKGROUND: The risk-benefit ratio of aspirin therapy in prevention of cardiovascular disease (CVD) remains contentious, especially in type 2 diabetes. This study examined the benefit and harm of low-dose aspirin (daily dose < 300 mg) in patients with type 2 diabetes. METHODS: This is a longitudinal observational study with primary and secondary prevention cohorts based on history of CVD at enrollment. We compared the occurrence of primary composite (non-fatal myocardial infarction or stroke and vascular death) and secondary endpoints (upper GI bleeding and haemorrhagic stroke) between aspirin users and non-users between January 1995 and July 2005. RESULTS: Of the 6,454 patients (mean follow-up: median [IQR]: 4.7 [4.4] years), usage of aspirin was 18% (n = 1,034) in the primary prevention cohort (n = 5731) and 81% (n = 585) in the secondary prevention cohort (n = 723). After adjustment for covariates, in the primary prevention cohort, aspirin use was associated with a hazard-ratio of 2.07 (95% CI: 1.66, 2.59, p < 0.001) for primary endpoint. There was no difference in CVD event rate in the secondary prevention cohort. Overall, aspirin use was associated with a hazard-ratio of 2.2 (1.53, 3.15, p < 0.001) of GI bleeding and 1.71 (1.00, 2.95, p = 0.051) of haemorrhagic stroke. The absolute risk of aspirin-related GI bleeding was 10.7 events per 1,000 person-years of treatment. CONCLUSION: In Chinese type 2 diabetic patients, low dose aspirin was associated with a paradoxical increase in CVD risk in primary prevention and did not confer benefits in secondary prevention. In addition, the risk of GI bleeding in aspirin users was rather high.
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Leung et al. (2009) conducted a cohort in Type 2 diabetes (n=6,454). Low-dose aspirin vs. Non-users was evaluated on Primary composite (non-fatal myocardial infarction or stroke and vascular death) in the primary prevention cohort (HR 2.07, 95% CI 1.66, 2.59, p=< 0.001). In Chinese patients with type 2 diabetes, low-dose aspirin use was associated with a paradoxical increased risk of cardiovascular events in primary prevention (HR 2.07) and no benefit in secondary prevention.
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