• J. Intern. Med. · Mar 2023

    Low-dose aspirin does not lower the risk of colorectal cancer in patients with type 2 diabetes taking metformin.

    • Jessica J P Shami, Vincent K C Yan, Yue Wei, Hassan Alwafi, Joseph E Blais, Eric Wan, WongCarlos K HCKHCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.Department of Family Medicine and Primary Care, School of Clinical Medici, Ka Shing Cheung, Wai K Leung, WongMartin C SMCSJockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong., WongIan C KICKCentre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Techno, and Esther W Chan.
    • Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.
    • J. Intern. Med. 2023 Mar 1; 293 (3): 371383371-383.

    BackgroundLow-dose aspirin and metformin have been individually associated with a reduced risk of cancer. Whether their concurrent use in adults with type 2 diabetes mellitus (T2DM) is associated with a reduced risk of colorectal cancer (CRC) is unclear.ObjectiveAmong individuals with T2DM taking metformin, we sought to evaluate the association between low-dose aspirin versus no aspirin and the risk of CRC.MethodsA multiple-database new-user cohort study of patients with T2DM taking metformin was conducted between 2007 and 2010 (Clinical Data Analysis and Reporting System [CDARS], Hong Kong) and 2007-2016 (The Health Improvement Network [THIN], UK). The primary outcome was incident CRC. Patients were followed from index date of prescription until the earliest occurrence of an outcome of interest, an incident diagnosis of any cancer, death, or until 31 December 2019. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CI). Estimates were pooled using an inverse variance random effects model, and heterogeneity was assessed using I2 .ResultsAfter one-to-one propensity-score matching, 57,534 patients were included (CDARS = 16,276; THIN = 41,258). The median (IQR) follow-up was 9.3 (6.5-10.7) years in CDARS and 3.2 (1.1-5.8) years in THIN. The concurrent use of low-dose aspirin and metformin was not associated with a lower risk of CRC compared to metformin only (HR = 0.89, 95% CI 0.75-1.05, I2  = 0%).ConclusionLow-dose aspirin was not associated with a lower risk of CRC in patients with T2DM taking metformin. Our study does not support the routine use of low-dose aspirin in this population.© 2022 The Association for the Publication of the Journal of Internal Medicine.

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