Comparative effect of aspirin versus clopidogrel monotherapy on incident type 2 diabetes in patients with atherosclerotic cardiovascular diseases: A target trial emulation study

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-03-08 DOI:10.1016/j.diabres.2025.112082

Chengsheng Ju , Xi Xiong , David T.W. Lui , Vincent K.C. Yan , Matthew Adesuyan , Ming Xu , Frederick K. Ho , Carlos K.H. Wong , Ian C.K. Wong , Esther W.Y. Chan , Li Wei

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Abstract

Aims

To compare the effects of low-dose aspirin and clopidogrel on the risk of incident type 2 diabetes among patients with ASCVD.

Methods

This target trial emulation study was performed using the IQVIA Medical Research Data UK primary care database, including adults with an incident first ASCVD event who initiated low-dose aspirin or clopidogrel between 2004 and 2021. We applied an overlap weighting approach to balance treatment groups. The observational analogues of intention-to-treat and per-protocol effects were estimated using pooled logistic regression.

Results

A total of 111,292 ASCVD patients who initiated aspirin (n = 78,012) or clopidogrel (n = 33,280) were included. In intention-to-treat analyses, aspirin and clopidogrel had similar risks of diabetes (Hazard ratio [HR] 1.02, 95 % Confidence interval [CI] 0.96 to 1.07), cardiovascular events (1.00, 0.95 to 1.05), and bleeding events (1.02, 0.97 to 1.08). In per-protocol analyses, risks remained comparable for diabetes (1.06, 0.97 to 1.15), cardiovascular events (0.96, 0.89 to 1.03), and bleeding events (1.01, 0.92 to 1.10).

Conclusions

Aspirin and clopidogrel have similar risks of incident diabetes, cardiovascular events, and bleeding events among patients with ASCVD. The choice between these agents may thus be influenced more by factors like cost, patient preference, or tolerance than by clinical outcomes alone.

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目的：比较低剂量阿司匹林和氯吡格雷对ASCVD患者2型糖尿病发病风险的影响：这项目标试验仿真研究使用了 IQVIA 医学研究数据英国初级保健数据库，包括 2004 年至 2021 年期间首次发生 ASCVD 事件并开始服用低剂量阿司匹林或氯吡格雷的成人。我们采用了重叠加权法来平衡治疗组。采用集合逻辑回归法估算了意向治疗效果和按方案治疗效果的观察类似物：共纳入了 111,292 例开始服用阿司匹林（n = 78,012 例）或氯吡格雷（n = 33,280 例）的 ASCVD 患者。在意向治疗分析中，阿司匹林和氯吡格雷的糖尿病风险（危险比 [HR] 1.02，95 % 置信区间 [CI] 0.96 至 1.07）、心血管事件风险（1.00，0.95 至 1.05）和出血事件风险（1.02，0.97 至 1.08）相似。在按协议分析中，糖尿病（1.06，0.97 至 1.15）、心血管事件（0.96，0.89 至 1.03）和出血事件（1.01，0.92 至 1.10）的风险仍然相当：阿司匹林和氯吡格雷在ASCVD患者中发生糖尿病、心血管事件和出血事件的风险相似。因此，这些药物之间的选择可能更多地受到成本、患者偏好或耐受性等因素的影响，而非仅仅受到临床结果的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.