Effects of aspirin treatment on survival in non-insulin-dependent diabeticpatients with coronary artery disease

PURPOSE: The benefit of aspirin treatment among diabetic patients with chro nic coronary artery disease is not well established. The purpose of this st udy was to assess the effect of aspirin on cardiac and total mortality in a large cohort of diabetic patients with established coronary artery disease and to compare it with the effect of aspirin in nondiabetic counterparts. PATIENTS AND METHODS: In this observational study among patients screened f or participation in the Bezafibrate Infarction Prevention Study, the effect s of aspirin treatment in 2,368 non-insulin-dependent diabetic patients wit h coronary artery disease were compared to those in 8,586 nondiabetic patie nts. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated wi th proportional hazards models. RESULTS: Fifty-two percent of diabetic patients and 56% of nondiabetic pati ents reported aspirin therapy. After 5.1 +/- 1.3 (mean +/- SD) years of fol low-up, the absolute benefit per 100 patients treated with aspirin was grea ter in diabetic patients than in nondiabetic patients (cardiac mortality be nefit: 5.0 versus 2.1, and all-cause mortality benefit: 7.8 versus 4.1). Ov erall cardiac mortality among diabetic patients treated with aspirin was 10 .9% versus 15.9% in the nonaspirin group (P <0.001), and all-cause mortalit y was 18.4% and 26.2% (P <0.001). After adjustment for possible confounders , treatment with aspirin was an independent predictor of reduced overall ca rdiac (HR = 0.8; 95% CI: 0.6-1.0) and all-cause mortality (HR = 0.8; 95% CI : 0.7-0.9) among diabetic patients, similar to those in nondiabetic patient s. CONCLUSION: Treatment with aspirin was associated with a significant reduct ion in cardiac and total mortality among noninsulin-dependent diabetic pati ents with coronary artery disease. The absolute benefit of aspirin was grea ter in diabetic patients than in those without diabetes. Am J Med. 1998;105 : 494-499. (C) 1998 by Excerpta Medica, Inc.