Kim Ye-Jee, Choi Nam-Kyong, Kim Mi-Sook, Lee Joongyub, Chang Yoosoo, Seong Jong-Mi, Jung Sun-Young, Shin Ju-Young, Park Ji-Eun, Park Byung-Joo
Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea.
Medical Research Collaborating Center, Seoul National University College of Medicine/Seoul National University Hospital, Seoul, Republic of Korea.
Diabetol Metab Syndr. 2015 Feb 15;7:8. doi: 10.1186/s13098-015-0002-y. eCollection 2015.
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.
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.
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.
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.
推荐使用低剂量阿司匹林以降低心血管疾病风险。然而，糖尿病患者中关于一级预防的问题已经出现。我们利用国家健康保险数据库评估了低剂量阿司匹林在糖尿病患者中预防缺血性卒中的使用情况。
利用韩国健康保险审查与评估服务数据库2005年1月1日至2009年12月31日的数据，对年龄在40至99岁之间、在2006年1月1日至2007年12月31日索引期首次使用低剂量阿司匹林的糖尿病新发患者进行了一项基于人群的回顾性队列研究。我们使用倾向评分将每位低剂量阿司匹林使用者与一位非使用者进行匹配。采用Cox比例风险模型比较低剂量阿司匹林使用者和非使用者直至2009年12月31日因缺血性卒中住院的风险。
在261,065例糖尿病新发患者中，15,849例（6.2%）为低剂量阿司匹林使用者。与非使用者相比，低剂量阿司匹林使用者因缺血性卒中住院的调整后风险比（95%置信区间）为1.73（95%CI：1.41 - 2.12）。在对随访期超过1年的研究对象进行的敏感性分析中，观察到略高的调整后风险比（1.97，95%CI：1.51 - 2.62）。在亚组分析中，无论性别、年龄或合并症如何，缺血性卒中住院风险均无显著变化。
在这项针对糖尿病患者的研究中，使用低剂量阿司匹林显示缺血性卒中住院风险增加。这些结果表明，对于糖尿病患者，应重新考虑使用低剂量阿司匹林进行缺血性卒中的一级预防。
