For Older Patients, Low-Dose Aspirin Could Reduce Diabetes Risk by 15%

Sophia Zoungas, MBBS, PhD
Credit: Monash University

An analysis of data from a landmark trial examining use of aspirin in older patients suggests daily use of low-dose aspirin could lower their risk of developing diabetes by up to 15%.

Using data from the ASPREE trial, which assessed use of low-dose aspirin on risk of cardiovascular events and mortality in patients aged 65 years or older, investigators determined users of low-dose aspirin experienced a 15% reduction in risk of developing diabetes and low-dose aspirin use could slow increases in fasting plasma glucose (FPG) levels.¹

“Aspirin treatment reduced incident diabetes and slowed the increase in fasting plasma glucose over time among initially healthy older adults,” wrote investigators.² “Given the increasing prevalence of type 2 diabetes among older adults, the potential for anti-inflammatory agents like aspirin to prevent type 2 diabetes or improve glucose levels needs further study.”

Presented as part of the Annual Meeting of the European Association for the Study of Diabetes (EASD) meeting, the current study was designed as an analysis of the ASPREE trial by Sophia Zoungas, endocrinologist and head of the School of Public Health and Preventive Medicine at Monash University, and colleagues with the intent of exploring whether the anti-inflammatory properties of aspirin might influence risk of diabetes in older adults.²

The initial ASPREE trial was a randomized, double-blind, placebo-controlled trial of daily low-dose aspirin conducted among community-dwelling people living in Australia or the US. Results of the trial were published in the New England Journal of Medicine in October 2018. The trial enrolled adults from Australia and the United States who were 70 years of age or older or 65 years of age or older among blacks and Hispanics in the United States. Overall, 19,114 patients were enrolled in the trial. Of these, 9525 were randomized to 100 mg of enteric-coated aspirin and 9589 were randomized to placebo.³

The original analysis, which included a median follow-up of 4.7 (Interquartile range [IQR], 3.6-5.7) years, use of aspirin was associated with a reduced rate of cardiovascular disease, with a rate of 10.7 events per 1000 person-years in the aspirin group and 11.3 events per 1000 person-years in the placebo group (hazard ratio, 0.95; 95% confidence interval [CI], 0.83 to 1.08). Further analysis suggested use of aspirin was associated with an increase in rate of major hemorrhage, with a rate of 8.6 events per 1000 person-years with aspirin relative to 6.2 events per 1000 person-years with placebo (HR, 1.38; 95% CI, 1.18-1.62; P <.001).³

In the EASD 2023 study led by Zoungas, investigators sought to examine the effect of aspirin on incident type 2 diabetes among older adults, specifically the effect on incident diabetes and fasting plasma glucose levels. The investigators’ analysis included all 16,209 participants from the trial and estimated the effects of aspirin on incident diabetes and FPG levels using Cox proportional hazards and linear mixed-effects regression models. For the purpose of analysis, incident diabetes was defined as self-report of diabetes, commencement of glucose-lowering medication, and/or an FPG of 7.0 mmol/L or greater at annual follow-up visits.¹

Among the 16,209 participants in the ASPREE trial, 995 incident diabetes cases were recorded, with 459 occurring among the aspirin group and 536 among the placebo group.¹

Upon analysis, results suggested use of aspirin was associated with a reduction in risk of incident diabetes (HR, 0.85; 95% CI, 0.75-0.97; P = .01). Additionally, patients using aspirin in the trial appeared to have a slower rate of increase in FPG relative to their counterparts receiving placebo therapy (difference in annual change, -0.006 mmol/L; 95% CI, -0.009 to -0.002; P = .004).¹

“The earlier published trial findings from ASPREE in 2018 showed aspirin did not prolong healthy independent living, but was associated with a significantly increased risk of bleeding, primarily in the gastrointestinal tract. Major prescribing guidelines now recommend older adults take daily aspirin only when there is a medical reason to do so, such as after a heart attack,” Zoungas said.² “Although these new findings are of interest, they do not change the clinical advice about aspirin use in older people at this time.”

References:

1. S Zoungas, Z Zhou, AJ Owen, et al. Effect of low dose aspirin on incident diabetes among older adults: post hoc analysis of the ASPREE randomised placebo-controlled trial. Presented at: Annual Meeting of the European Association for the Study of Diabetes (EASD) meeting. Hamburg, Germany. October 2 - 6, 2023.
2. Naylor J. Study shows that low-dose aspirin associated with a 15% lower risk of developing diabetes in people aged over 65 years. EurekAlert! August 31, 2023. Accessed August 31, 2023. https://www.eurekalert.org/news-releases/1000081.
3. McNeil JJ, Nelson MR, Woods RL, et al. Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. N Engl J Med. 2018;379(16):1519-1528. doi:10.1056/NEJMoa1803955