Aspirin treatment and risk of first
incident cardiovascular diseases in
patients with type 2 diabetes: an
observational study from the Swedish
National Diabetes Register

Nils Ekström,
1
Jan Cederholm,
2
Björn Zethelius,
3
Björn Eliasson,
1
Eva Fhärm,
4
Olov Rolandsson,
4
Mervete Miftaraj,
5
Ann-Marie Svensson,
5
Soffia Gudbjörnsdottir
1,5

Abstract
. Aspirin treatment and
risk of first incident
cardiovascular diseases in
patients with type 2 diabetes:
an observational study from
the Swedish National
Diabetes Register.
BMJOpen
2013;

Objectives:
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.
Design:
Population-based cohort study between 2005
and 2009, mean follow-up 3.9 years.
Setting:
Hospital outpatient clinics and primary care
in Sweden.
Participants:
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).
Main outcome measures:
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.

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