Aspirin is associated with reduced cardiovascular and all-cause mortality in type 2 diabetes in a primary prevention setting: the Fremantle Diabetes study.
OBJECTIVE
To determine whether regular aspirin use (> or =75 mg/day) is independently associated with cardiovascular disease (CVD) and all-cause mortality in community-based patients with type 2 diabetes and no history of CVD.


METHODS
Of the type 2 diabetic patients recruited to the longitudinal observational Fremantle Diabetes Study, 651 (50.3%) with no prior CVD history at entry between 1993 and 1996 were followed until death or the end of June 2007, representing a total of 7,537 patient-years (mean +/- SD 11.6 +/- 2.9 years). Cox proportional hazards modeling was used to determine independent baseline predictors of CVD and all-cause mortality including regular aspirin use.


RESULTS
There were 160 deaths (24.6%) during follow-up, with 70 (43.8%) due to CVD. In Kaplan-Meier survival analysis, there was no difference in either CVD or all-cause mortality in aspirin users versus nonusers (P = 0.52 and 0.94, respectively, by log-rank test). After adjustment for significant variables in the most parsimonious Cox models, regular aspirin use at baseline independently predicted reduced CVD and all-cause mortality (hazard ratio [HR] 0.30 [95% CI 0.09-0.95] and 0.53 [0.28-0.98[, respectively; P < or = 0.044). In subgroup analyses, aspirin use was independently associated with reduced all-cause mortality in those aged > or =65 years and men.


CONCLUSIONS
Regular low-dose aspirin may reduce all-cause and CVD mortality in a primary prevention setting in type 2 diabetes. All-cause mortality reductions are greatest in men and in those aged > or =65 years. The present observational data support recommendations that aspirin should be used in primary CVD prevention in all but the lowest risk patients.
Ong
Greg
G
School of Medicine and Pharmacology, University of Western Australia, Crawley, Western Australia, Australia.
Davis
Timothy M E
TM
Davis
Wendy A
WA
D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use*; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000401:mortality* / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000401:mortality* / Q000517:prevention & control; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011322:Primary Prevention / Q000379:methods; D016016:Proportional Hazards Models; D012727:Sex Characteristics; D012907:Smoking / Q000453:epidemiology; D016019:Survival Analysis
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000960:Hypolipidemic Agents; D001241:Aspirin