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Open AccessArticle

Effects of Aspirin or Clopidogrel on Colorectal Cancer Chemoprevention in Patients with Type 2 Diabetes Mellitus

by Yi-Chun Kuan 1,2,3,4,5,6,†, Kuang-Wei Huang 7,†, Cheng-Li Lin 8,9, Jiing-Chyuan Luo 10 and Chia-Hung Kao 11,12,13,14,*
1
Taipei Neuroscience Institute, Taipei Medical University, Taipei 11031, Taiwan
2
Department of Neurology, Taipei Medical University-Shuang Ho Hospital, New Taipei City 23561, Taiwan
3
Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
4
Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei 10617, Taiwan
5
Cochrane Taiwan, Taipei Medical University, Taipei 11031, Taiwan
6
Center for Evidence-Based Health Care, Taipei Medical University—Shuang Ho Hospital, New Taipei City 23561, Taiwan
7
Division of Gastroenterology, Department of Internal Medicine, Taipei Beitou Health Management Hospital, Taipei 11252, Taiwan
8
Management Office for Health Data, China Medical University Hospital, Taichung 40402, Taiwan
9
College of Medicine, China Medical University, Taichung 40402, Taiwan
10
Division of Gastroenterology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
11
Graduate Institute of Biomedical Sciences and School of Medicine, College of Medicine, China Medical University, Taichung 40402, Taiwan
12
Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung 40402, Taiwan
13
Department of Bioinformatics and Medical Engineering, Asia University, Taichung 41454, Taiwan
14
Center of Augmented Intelligence in Healthcare, China Medical University Hospital, Taichung 40402, Taiwan
*
Author to whom correspondence should be addressed.
These authors contributed equally to this article.
Cancers 2019, 11(10), 1468; https://doi.org/10.3390/cancers11101468
Received: 11 September 2019 / Revised: 26 September 2019 / Accepted: 27 September 2019 / Published: 29 September 2019
Background: The effect of clopidogrel, whose mechanism of action differs from that of aspirin, on CRC risk remains unknown. We investigated the effects of clopidogrel and aspirin, either as monotherapy or combined, on colorectal cancer (CRC) risk in patients with Type 2 diabetes mellitus (T2DM). Methods: We conducted a cohort study using Taiwan National Health Insurance Research Database. Four groups comprising 218,903 patients using aspirin monotherapy, 20,158 patients using clopidogrel monotherapy, 42,779 patients using dual antiplatelet therapy, and 281,840 nonuser matched controls were created using propensity score matching. Cox proportional hazards regression was used to evaluate the CRC risk during follow-up. Results: During the 13-year follow-up period, we found 9431 cases of CRC over 3,409,522 person-years. The overall incidence rates of CRC were 2.04, 3.45, 1.55, and 3.52 per 1000 person-years in the aspirin, clopidogrel, dual antiplatelet, and nonuser cohorts, respectively. The adjusted hazard ratios (aHRs) were 0.59 (95% confidence interval [CI], 0.56–0.61), 0.77 (95% CI, 0.68–0.87), and 0.37 (95% CI, 0.33–0.40) for the aspirin, clopidogrel, and dual antiplatelet cohorts, respectively. Dose- and duration-dependent chemopreventive effects were observed in the three cohorts. View Full-Text
Keywords: colorectal cancer; Type 2 diabetes mellitus; aspirin; clopidogrel colorectal cancer; Type 2 diabetes mellitus; aspirin; clopidogrel
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Kuan, Y.-C.; Huang, K.-W.; Lin, C.-L.; Luo, J.-C.; Kao, C.-H. Effects of Aspirin or Clopidogrel on Colorectal Cancer Chemoprevention in Patients with Type 2 Diabetes Mellitus. Cancers 2019, 11, 1468.

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