Aspirin versus clopidogrel on incident type 2 diabetes in patients with CVD

Abstract

<p>Aims: To compare the effects of low-dose aspirin versus clopidogrel on the risk of incident type 2<br>diabetes, cardiovascular events, and bleeding events among patients with CVD.<br>Methods: We emulated a pragmatic trial to compare aspirin and clopidogrel monotherapy among<br>patients with coronary artery disease, stroke/transient ischaemic attack, or peripheral arterial<br>disease. We used overlap and inverse probability of censoring weight to account for confounding and<br>artificial censoring. We estimated the observational analogues of intention-to-treat (ITT) and perprotocol<br>(PP) effects in hazard ratios (HRs) and eight-year absolute risk (AR) using pooled logistic<br>regression models.<br>Results: 78,012 and 33,280 patients initiated aspirin or clopidogrel monotherapy after CVDs were<br>included. Aspirin was not associated with a lower risk of diabetes (ITT effect: HR, 1.01; 95%CI, 0.96-<br>1.07; AR, 13.2% vs 13.4%. PP effect: HR, 1.04; 95%CI, 0.96-1.12; AR, 13.5% vs 13.1%) or bleeding<br>events (ITT effect: HR, 1.01; 95%CI, 0.95-1.06; AR, 13.2% vs 12.7%. PP effect: HR, 0.98; 95%CI, 0.91-<br>1.07; AR, 12.6% vs 12.4%), compared with clopidogrel. Aspirin was associated with a higher risk of<br>cardiovascular events than clopidogrel in ITT analysis (HR, 1.06; 95%CI, 1.02-1.11; AR, 21.1% vs<br>20.0%) but not in PP analysis (HR, 1.03; 95%CI, 0.98-1.09; AR, 17.9% vs 17.8%).<br>Discussion: Aspirin and clopidogrel have similar risks concerning incident diabetes, acute<br>cardiovascular events, and bleeding events among patients with CVD. The results provide evidence of<br>the real-world comparative effectiveness of the two most commonly used antiplatelet drugs and<br>could guide the choice of antiplatelet therapy for patients without diabetes.<br></p>