J Korean Diabetes Assoc.  2006 Sep;30(5):363-371. 10.4093/jkda.2006.30.5.363.

Current Status of Aspirin User in Korean Diabetic Patients Using Korean Health Insurance Database

• Park IB
• Kim DJ
• Kim J
• Kim H
• Kim H
• Min KW
• Park SW
• Park JH
• Baik SH
• Son HS
• Ahn CW
• Oh JY
• Lee S
• Lee J
• Chung CH
• Choi I
• Choi KM

• KMID: 2008266
• DOI: http://doi.org/10.4093/jkda.2006.30.5.363

Abstract

AIMS: ADA guidelines recommend aspirin for all patients with diabetes who have had a prior CHD events as well as a primary prevention strategy among those with at least one other risk factor. We examined the current status of regular aspirin intake among Korean adults who diagnosed as diabetes.
METHODS
This study examined the characteristics of aspirin user in new-onset diabetes over 40 years based on health insurance claims submitted to the Health Insurance Review Agency (HIRA) of Korea during the period from January 2001 through December 2003. New onset diabetes defined as the first health insurance claim of antidiabetic drugs submitted to HIRA for the three months (January to March 2001) that never submitted for previous 6 years.
RESULTS
The number of total new-onset diabetic patients was 30,014 in 2001, 29,819 in 2002, and 32,061 in 2003. The incidence rate of diabetes over 40 years for 3 months in 2001, 2002 and 2003 were 0.172%, 0.167% and 0.18. Mean age of women who diagnosed diabetes were significant higher than that of men in 2001 (women 59.2+/-10.6 yrs, men 54.8+/-9.8 yrs), in 2002 (women 59.5+/-10.6 yrs, men 54.6+/-9.3 yrs) and in 2003 (women 59.6+/-10.7 yrs, men 54.7+/-9.9 yrs) (p < 0.001). The number of aspirin user increased from 2,065 (6.9%) in 2001, 2,638 (8.9%) in 2002 and 3,711 (11.6%) in 2003. 30.5% of new-onset diabetics in 2001 had hypertension, 12.4% of them had hypercholesterolemia, 11.8% of them had cerebral infarct, 2.6% of them had cerebral hemorrhage, 3.8% of them had coronary heart disease and, but, 55.6% of them had not any CVD. Logistic regression analysis using aspirin use as a dependent variable showed that the number of aspirin use in patients with hypertension, hypercholesterolemia, cerebral infarct and coronary heart disease was higher than in patients without those (hypertension [OR], 3.89 (95% CI, 3.52~4.31); hypercholesterolemia [OR], 2.16 (95% CI, 1.90~2.46; cerebral infarct [OR], 2.05 (95% CI, 1.82~2.30); coronary heart disease [OR], 9.41 (95% CI, 8.20~10.80), respectively). Coronary heart disease was the most important associated factor of aspirin use.
CONCLUSIONS
We found significant underuse of aspirin therapy among our population compared with that of America. Major efforts are needed to increase aspirin use in diabetic patients.

Keyword

Aspirin; Cardiovascular disease; Diabetes

MeSH Terms

Adult
Americas
Aspirin*
Cardiovascular Diseases
Cerebral Hemorrhage
Coronary Disease
Female
Humans
Hypercholesterolemia
Hypertension
Hypoglycemic Agents
Incidence
Insurance, Health*
Korea
Logistic Models
Male
Primary Prevention
Risk Factors
Aspirin
Hypoglycemic Agents

Reference

1. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care. 1993. 16:434–444.

2. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998. 339:229–234.

3. American Diabetes Association. Standards of medical care in diabetes2006. Diabetes Care. 2006. S4–S42.

4. Colwell JA, Nesto RW. The platelet in diabetes: focus on prevention of ischemic events. Diabetes Care. 2003. 26:2181–2188.

5. US Preventive Services Task Force. Aspirin for the primary prevention of cardiovascular events: recommendation and rationale. Ann Intern Med. 2002. 136:157–160.

6. The ETDRS Investigators. Aspirin effects on mortality and morbidity in patients with diabetes mellitus: Early Treatment Diabetic Retinopathy Study report 14. JAMA. 1992. 268:1292–1300.

7. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial: HOT study group. Lancet. 1998. 351:1755–1762.

8. Antiplatelet Trialists' Collaboration. Collaborative overview of randomised trials of antiplatelet therapy-I. Prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994. 308:81–106.

9. Rolka DB, Fagot-Campagna A, Narayan KM. Aspirin use among adults with diabetes: estimates from the Third National Health and Nutrition Examination Survey. Diabetes Care. 2001. 24:197–201.

10. Krein SL, Vijan S, Pogach LM, Hogan MM, Kerr EA. Aspirin Use and Counseling About Aspirin Among Patients With Diabetes. Diabetes Care. 2002. 25:965–970.

11. International Diabetes Federation. Diabetes Atlas. 2003. 2nd ed. Belgium: International Diabetes Federation;17–71.

12. Kim SM, Lee JS, Lee J, Na JK, Han JH, Yoon DK, Baik SH, Choi DS, Choi KM. Prevalence of diabetes and impaired fasting glucose in Korea: Korean National Health and Nutrition Survey 2001. Diabetes Care. 2006. 29:226–231.

15. Shin CS, Lee HK, Koh C-S, Kim YI, Shin YS, Yoo KY, Paik HY, Park YS, Yang BG. Risk factors for the development of NIDDM in Yonchon County, Korea. Diabetes Care. 1997. 20:1842–1846.

16. Morimoto T, Fukui T, Lee TH, Matsui K. Application of U.S. guidelines in other countries: aspirin for the primary prevention of cardiovascular events in Japan. Am J Med. 2004. 117:459–468.

17. Rodondi N, Bauer DC. Assessing the risk/benefit profile before recommending aspirin for the primary prevention of cardiovascular events. Am J Med. 2004. 117:528–530.