Aspirin Use and Cardiovascular Outcome in Patients With Type 2 Diabetes Mellitus and Heart Failure: A Population‐Based Cohort Study

Background Aspirin is of uncertain benefit for primary prevention in patients with type 2 diabetes mellitus (T2D). We assessed whether primary prevention with aspirin is beneficial in patients with T2D and heart failure ( HF ). Methods and Results Data from The Health Improvement Network, a UK multicenter prospective primary care database, were analyzed. Those with T2D and HF , age ≥55 years, and no previous history of myocardial infarction and/or coronary artery disease, stroke, peripheral artery disease, or atrial fibrillation were included. We compared outcomes for those on aspirin to no aspirin after diagnosis of HF and T2D and assessed the role of a >75-mg dose. The primary outcome was a composite of all-cause mortality and hospitalization for HF ; secondary outcomes were nonfatal stroke, nonfatal myocardial infarction, or major bleeding. There were 5967 participants on aspirin and 6567 not on aspirin. The mean age ( SD ) was 75.3 (9.6) years, 53.9% were men, and the mean follow-up ( SD ) was for 5 (4.2) years. After propensity-score matching and further multivariable adjustment, aspirin was significantly associated with a decrease in the primary outcome and all-cause mortality (hazard ratio=0.88, 95% confidence interval 0.82-0.93; 0.88, 0.83-0.94], respectively); and an increased risk of nonfatal myocardial infarction (hazard ratio=1.66; 95% confidence interval 1.49-1.85) and nonfatal stroke (hazard ratio=1.23, 1.01-1.50). Major bleedings and hospitalization for HF were not significantly higher with aspirin (hazard ratio=0.68, 0.45-1.03; 0.87, 0.66-1.15, respectively). There was no additional benefit for a dose >75 mg. Conclusions Primary prevention with aspirin in patients with T2D and HF is associated with lower all-cause mortality.