Background/Purpose: Patients with both Type 2 diabetes mellitus (T2DM) and systemic lupus erythematosus (SLE) face an increased risk of cardiovascular complications due to the compounding effects of both conditions. While low-dose aspirin is commonly prescribed for cardioprotection, its specific benefits in this dual-diagnosis population remain unclear. This study aimed to evaluate the impact of low-dose aspirin (81mg) on cardiovascular and other clinical outcomes in patients with both T2DM and SLE.

Methods: Using the TriNetX global federated health research network encompassing 101 healthcare organizations, we conducted a retrospective propensity score-matched cohort study of adults (18-99 years) with both T2DM and SLE diagnoses. Patients were divided into cohorts receiving low-dose aspirin (81mg) (n=14,221) or no aspirin (n=14,221). Propensity score matching was performed to balance demographics and comorbidities between groups. Primary outcomes included mortality, cardiac arrest, cardiovascular events, and other complications measured during a 365-day follow-up period after index date. Hazard ratios (HR) and 95% confidence intervals were calculated using survival analysis.

Results: After propensity score matching, patients receiving low-dose aspirin had significantly lower rates of all-cause mortality (HR 1.471, 95% CI 1.330-1.626, p< 0.001), cardiac arrest (HR 2.369, 95% CI 1.884-2.979, p< 0.001), sepsis (HR 1.748, 95% CI 1.601-1.909, p< 0.001), acute kidney failure (HR 1.767, 95% CI 1.660-1.880, p< 0.001), and atrial fibrillation (HR 1.836, 95% CI 1.697-1.986, p< 0.001) compared to non-aspirin users. The aspirin group also showed lower incidence of cerebral infarction (HR, 1.838, 95% CI 1.591-2.123, p< 0.001), ventricular tachycardia (HR 2.163, 95% CI 1.808-2.587, p< 0.001), and heart failure (HR 1.713, 95% CI 1.583-1.852, p< 0.001). Notably, aspirin users had significantly lower rates of hypoglycemic events (HR 1.992, 95% CI 1.612-2.462, p< 0.001).

Conclusion: In patients with both T2DM and SLE, low-dose aspirin therapy was associated with significantly reduced risk of mortality and major cardiovascular complications. The protective effect extended to renal outcomes and hypoglycemic events. These findings support the use of low-dose aspirin as part of comprehensive cardiovascular risk management in this high-risk population. Future prospective trials are needed to confirm these observations and optimize therapeutic strategies.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-dose-aspirin-therapy-in-patients-with-type-2-diabetes-and-systemic-lupus-erythematosus-a-propensity-matched-cohort-study/