Evaluation of low-dose aspirin for primary prevention of ischemic stroke among patients with diabetes: a retrospective cohort study.
BACKGROUND
Low-dose aspirin is recommended to reduce the risk of cardiovascular disease. However, the questions with regard to primary prevention have been raised among patients with diabetes. We evaluated low-dose aspirin use for preventing ischemic stroke in patients with diabetes using a national health insurance database.


METHODS
Using data from the Korean Health Insurance Review and Assessment Service database from January 1, 2005, through December 31, 2009, a population-based retrospective cohort study was conducted with incident patients with diabetes aged 40 to 99 years old with the initial use of low-dose aspirin during the index period from January 1, 2006 to December 31, 2007. We matched each low-dose aspirin user to one non-user using a propensity score. The Cox proportional hazards model was used to compare the risk of hospitalization for ischemic stroke in users and nonusers of low-dose aspirin until December 31, 2009.


RESULTS
Out of 261,065 incident patients with diabetes, 15,849 (6.2%) were low-dose aspirin users. Compared to non-users, the adjusted hazard ratio (95% confidence interval) of low-dose aspirin users for hospitalization due to ischemic stroke was 1.73 (95% CI; 1.41-2.12). In a sensitivity analysis of study subjects with more than 1 year follow-up periods, slightly higher adjusted hazard ratio (1.97, 95% CI; 1.51-2.62) was observed. In the subgroup analyses, there were no significant changes in the risk of hospitalization for ischemic stroke irrespective of gender, age, or comorbidity.


CONCLUSIONS
In this study of patients with diabetes, the use of low-dose aspirin showed an increased risk of hospitalization for ischemic stroke. These results suggest that low-dose aspirin use for the primary prevention of ischemic stroke should be reconsidered in patients with diabetes.
Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
Ye-Jee
YJ
Kim
Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea.|Institute of Environmental Medicine, Seoul National University Medical Research Center, , Seoul, Republic of Korea.
Nam-Kyong
NK
Choi
Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
Mi-Sook
MS
Kim
Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea.
Joongyub
J
Lee
Center for Cohort Studies, Total Healthcare Screening Center, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Republic of Korea.
Yoosoo
Y
Chang
Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
Jong-Mi
JM
Seong
Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
Sun-Young
SY
Jung
Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
Ju-Young
JY
Shin
National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.|Department of Health Care Management and Policy, School of Public Health, National University, Seoul, Republic of Korea.
Ji-Eun
JE
Park
Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.|Department of Preventive Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.|National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea.
Byung-Joo
BJ
Park
Aspirin; Diabetes mellitus; Health insurance claims database; Ischemic stroke; Retrospective cohort study