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 (>= 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. RESEARCH DESIGN AND 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 <= 0.044). In subgroup analyses, aspirin use was independently associated with reduced all-cause mortality in those aged >= 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 >= 65 years. The present observational data support recommendations that aspirin should be used in primary CVD prevention in all but the lowest risk patients.