Aspirin Use and Risk of Type 2 Diabetes in Apparently Healthy Men

published online 23 February 2009.

Abstract

Background

Epidemiologic data on aspirin use and the risk of diabetes are limited. The Physician's Health Study has accumulated 22 years of follow-up data, including 5 years of randomized data, from 22,071 apparently healthy men.

Methods and Results

At baseline and in yearly follow-up questionnaires, participants self-reported a history of diabetes, aspirin use, and various lifestyle factors. To evaluate the association between aspirin use and risk of subsequent diabetes, we used a Cox proportional hazards model with time-varying regression coefficients. During the 22 follow-up years, 1719 cases of diabetes were reported. The multivariable-adjusted hazard ratio of developing diabetes was 0.86 (95% confidence interval [CI], 0.77-0.97) for those who self-selected any aspirin. During the 5 years of randomized treatment, 318 cases of diabetes were observed, with a hazard ratio of 0.91 (95% CI, 0.73-1.14) for those randomized to aspirin.

Conclusion

Our data suggest a small but not significant decrease in the risk of diabetes during 5 years of randomized comparison of 325 mg of aspirin every other day. This trend was continued during 22 years of follow-up, indicating that self-selection of any use of aspirin is associated with a significant, approximately 14% decrease in the risk of diabetes. Decreased risk of type 2 diabetes may be added to the list of the clinical benefits of aspirin.

Keywords: Aspirin, Cohort study, Diabetes, Epidemiology, Incidence, Men

a Department of Epidemiology and Healthcare Research, Kyoto University Graduate School of Medicine, Kyoto, Japan

b Departments of Medicine and Epidemiology and Public Health, University of Miami School of Medicine, Miami, Fla

c Department of Clinical Science and Medical Education and Center of Excellence, Florida Atlantic University, Boca Raton

d Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass

e Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass

f Department of Epidemiology, Harvard School of Public Health, Boston, Mass

Requests for reprints should be addressed to Yasuaki Hayashino, MD, DMSc, PMH, Kyoto University Graduate School of Medicine, Department of Epidemiology and Healthcare Research, Yoshida-konoe-cho, Sakyo-ku, Kyoto, Japan 606-8501

Funding: The Physicians Health Study was supported by grants CA-34944, CA-40360, and CA-097193 from the National Cancer Institute and grants HL-26490 and HL-34595 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. The study sponsors were not involved in the design and conduct of the study; the collection, management, analysis, and interpretation of the data; or the preparation, review, or approval of the manuscript.

Conflict of Interest: Dr Hayashino has nothing to disclose. Dr Hennekens is funded by the Charles E. Schmidt College of Biomedical Science, Department of Clinical Science and Medical Education and Center of Excellence at Florida Atlantic University (FAU) as Principal Investigator on 2 investigator-initiated research grants funded to FAU by Bayer testing the effects of aspirin dose on platelet biomarkers, inflammatory markers, nitric oxide formation, and endothelial function; he serves as an independent scientist in an advisory role to investigators and sponsors, including as Chair or Member on Data and Safety Monitoring Boards, for Actelion, Amgen, AstraZeneca, Bayer, Biovail, Bristol-Myers Squibb, Chattem, Dainippon Sumitomo, Delaco, Dechert, Food and Drug Administration, GlaxoSmithKline, Keryx, Lilly, McNeil, Merck, National Association for Continuing Education, National Institutes of Health, Novartis, Pfizer, PriMed, Reliant, Sanofi-Aventis, Sidley Austin, Solvay, TAP, United BioSource Corporation, UpToDate and Wyeth; he serves on speakers bureaus for the International Atherosclerosis Society, AstraZeneca concerning lipids and heart failure, as well as Bristol-Myers Squibb, Reliant, and Pfizer concerning lipids; he receives royalties for authorship or editorship of 3 textbooks; he receives royalties as co-inventor on patents concerning inflammatory markers and cardiovascular disease which are held by Brigham and Women's Hospital; he has an investment management relationship with SunTrust Bank who has sole discretionary investment authority. Dr Kurth has received within the last 5 years investigator-initiated research funding as Principal or Co-Investigator from the National Institutes of Health, Bayer AG, McNeil Consumer and Specialty Pharmaceuticals, Merck, and Wyeth Consumer Healthcare; he is a consultant to i3 Drug Safety and WHISCON; he received an honorarium from Organon for contributing to an expert panel and from Genzyme and Pfizer for educational lectures.

Authorship: All authors had access to the data and played a role in writing this manuscript.

PII: S0002-9343(08)01105-4

doi:10.1016/j.amjmed.2008.09.044

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