Effectiveness study on aspirin chemoprophylaxis in patients with diabetes
Date Issued
2015
Date
2015
Author(s)
Lin, Cheng-Ching
Abstract
Background and objective Diabetes increases the risk of the incidence of many types of cancer. Aspirin has been proposed as a potentially effective chemopreventive agent for cancer for many years. Some studies have suggested that aspirin use can reduce the risk of colorectal cancer. Most of the previous studies have focused on the general population, and none have focused specifically on patients with diabetes. The purpose of this study was to evaluate whether low-dose aspirin can reduce the risk of colorectal cancer and hepatocellular carcinoma and increase the risk of gastrointestinal bleeding in people with diabetes using a population-based reimbursement database. Material and methods We studied ≥ 30-year-old patients with diabetes included in the Longitudinal Health Insurance Database 2005 in Taiwan, who were treated with hypoglycaemic drugs during 2000 to 2009. We used a time-varying Cox regression model to adjust for immortal time bias and to estimate the adjusted hazard ratio (HR) and 95% CI for the association between low-dose aspirin use and colorectal cancer, hepatocellular carcinoma and gastrointestinal bleeding occurrence. Results In the diabetes and colorectal cancer cohort, low-dose aspirin use >5 times/week (high frequency) for 4–5 years (moderate duration) and >5 years (long duration) was found to reduce the risk of colorectal cancer by 47% and 58% respectively (HR: 0.53, 95% CI: 0.30–0.96；HR: 0.42, 95% CI: 0.27–0.65). Low and moderate frequency (≤2 and 3–5 times/week) and short and moderate duration (≤3 and 4–5 years) of low-dose aspirin use did not reduce the risk of colorectal cancer. In the diabetes and hepatocellular carcinoma cohort, low-dose aspirin use ≤2, 3–5 and >5 times/week for >5 years was found to reduce the risk of hepatocellular carcinoma by 41%, 53% and 65%, respectively (HR: 0.59, 95% CI: 0.40–0.89; HR: 0.47, 95% CI: 0.31–0.72; HR: 0.35, 95% CI: 0.23–0.54). Low-dose aspirin use >5 times/week for 4–5 years reduced the risk of hepatocellular carcinoma by 41% (HR: 0.59, 95% CI: 0.37–0.96). Low and moderate frequency and short and moderate duration of low-dose aspirin use did not reduce the risk of hepatocellular carcinoma. In the diabetes and gastrointestinal bleeding cohort, low-dose aspirin use ≤5 times/week for ≤5 years was found to increase the risk of gastrointestinal bleeding. Low-dose aspirin use >5 times/week for >5 years reduced the risk of gastrointestinal bleeding (HR:0.58, 95% CI:0.48–0.71). Conclusions Low-dose aspirin use with high frequency (> 5 times/week) and long duration (> 5 years) reduced the risk of colorectal cancer. Low-dose aspirin use for long duration reduced the risk of hepatocellular carcinoma in patients with diabetes in a frequency-dependent manner, whereas low and moderate frequency and short and moderate duration of low-dose aspirin use did not. Low-dose aspirin use will increase the risk of gastrointestinal bleeding in patients with diabetes. Further studies should evaluate the frequency and duration of low-dose aspirin use that are sufficient to prevent the incidence of colorectal cancer and hepatocellular carcinoma and not increase the risk of gastrointestinal bleeding in patients with diabetes.
Subjects
diabetes
low-dose aspirin
colorectal cancer
hepatocellular carcinoma
gastrointestinal bleeding
immortal time
SDGs
Type
thesis
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