title: Aspirin treatment and risk of first incident cardiovascular diseases in patients with type 2 diabetes: an observational study from the Swedish National Diabetes Register.
abstract: OBJECTIVE
  To investigate the benefits and risks associated with aspirin treatment in patients with type 2 diabetes and no previous cardiovascular disease (CVD) in clinical practice.
  
  
  METHODS
  Population-based cohort study between 2005 and 2009, mean follow-up 3.9 years.
  
  
  METHODS
  Hospital outpatient clinics and primary care in Sweden.
  
  
  METHODS
  Men and women with type 2 diabetes, free from CVD, including atrial fibrillation and congestive heart failure, at baseline, registered in the Swedish National Diabetes Register, with continuous low-dose aspirin treatment (n=4608) or no aspirin treatment (n=14 038).
  
  
  METHODS
  Risks of CVD, coronary heart disease (CHD), stroke, mortality and bleedings, associated with aspirin compared with no aspirin, were analysed in all patients and in subgroups by gender and estimated cardiovascular risk. Propensity scores were used to adjust for several baseline risk factors and characteristics at Cox regression, and the effect of unknown covariates was evaluated in a sensitivity analysis.
  
  
  RESULTS
  There was no association between aspirin use and beneficial effects on risks of CVD or death. Rather, there was an increased risk of non-fatal/fatal CHD associated with aspirin; HR 1.19 (95% CI 1.01 to 1.41), p=0.04. The increased risk of cardiovascular outcomes associated with aspirin was seen when analysing women separately; HR 1.41 (95% CI 1.07 to 1.87), p=0.02, and HR 1.28 (95% CI 1.01 to 1.61), p=0.04, for CHD and CVD, respectively, but not for men separately. There was a trend towards increased risk of a composite of bleedings associated with aspirin, n=157; HR 1.41 (95% CI 0.99 to 1.99).
  
  
  CONCLUSIONS
  The results support the trend towards more restrictive use of aspirin in patients with type 2 diabetes and no previous CVD. More research is needed to explore the differences in aspirin's effects in women and men.
authors.affiliation: Department of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.
authors.forename: Nils
authors.initials: N
authors.lastname: Ekström
authors.forename: Jan
authors.initials: J
authors.lastname: Cederholm
authors.forename: Björn
authors.initials: B
authors.lastname: Zethelius
authors.forename: Björn
authors.initials: B
authors.lastname: Eliasson
authors.forename: Eva
authors.initials: E
authors.lastname: Fhärm
authors.forename: Olov
authors.initials: O
authors.lastname: Rolandsson
authors.forename: Mervete
authors.initials: M
authors.lastname: Miftaraj
authors.forename: Ann-Marie
authors.initials: AM
authors.lastname: Svensson
authors.forename: Soffia
authors.initials: S
authors.lastname: Gudbjörnsdottir