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September 9, 1992

Aspirin Effects on Mortality and Morbidity in Patients With Diabetes Mellitus: Early Treatment Diabetic Retinopathy Study Report 14

Aaron Kassoff, MD; Sheldon M. Buzney, MD; J. Wallace McMeel, MD; et al John J. Weiter, MD, PhD; Gerald J. Doyle, MD; Rodney L. Immerman, OD; Gerald R. Friedman, OD; Michael L. Klein, MD; Richard Dreyer, MD; Richard Chenoweth, MD; Irvin Handelman, MD; Richard Hohl, MD; Robert Biesbroeck, MD; Jack Sipperley, MD; Charles A. Garcia, MD; Michael A. Bloome, MD; Richard S. Ruiz, MD; F. Tempel Riekhof, MD; William A. Bohart, MD; Roy A. Goodart, MD; Dana H. Clarke, MD; David H. Orth, MD; Timothy P. Flood, MD; Kirk H. Packo, MD; Jayant Malhotra, MD; Akbar Rahmani, MD; Edward J. Winter, MD; Harish Bhatia, MD; Robert P. Murphy, MD; Stuart L. Fine, MD; Michael J. Elman, MD; Frederick L. Ferris III, MD; Thaddeus E. Prout, MD; Arnall Patz, MD; Thomas A. Rice, MD; David Newsome, MD; Lloyd M. Aiello, MD; Lawrence I. Rand, MD; Sabera T. Shah, MD; Ramachandiran Cooppan, MD; Jerry Cavallerano, OD, PhD; Robert Poole, OD; Philip Silver, OD; Jose Briones Jr, MD; Mohammed Z. Wafai, MD; Abdul C. Asmal, MD, PhD; Rudolph M. Franklin, MD; Laurence Arend, MD; Donald Bergsma, MD; Lance Turkish, MD; Paul Beer, MD; Denis Carroll, MD; Edgar Thomas, MD; Thomas C. Burton, MD; Gary W. Abrams, MD; Hak-Joong Kim, MD; George A. Williams, MD; Trexler M. Topping, MD; Frederick H. Reeser, MD; Thomas M. Aaberg, MD; Gregory S. Brinton, MD; James K. Kingham, MD; Travis A. Meredith, MD; Raymond R. Margherio, MD; Patrick L. Murphy, MD; Morton S. Cox, MD; Michael Trese, MD; Steven Winokur, MD; Everett Ai, MD; Robert Sorenson, MD; Gary Arsham, MD; John Cavender, MD; Stanley M. Kopelow, MD; Alan L. Shabo, MD; Jose C. Briones Jr, MD; Richard D. Hornichter, MD; Norman P. Blair, MD; Morton F. Goldberg, MD; C. Ronald Lindberg, MD; Neil L. Ross, MD; Lynn E. Hauser, MD; Jose Cunha-Vaz, MD, PhD; J. Terry Ernest, MD, PhD; James C. Liang, MD; Steven B. Cohen, MD; Charles Vygantas, MD; Gerald Williams, MD; Harry W. Flynn Jr, MD; George W. Blankenship, MD; William H. Knobloch, MD; Robert C. Ramsay, MD; Herbert L. Cantrill, MD; Frederick C. Goetz, MD; Byron Hoogwerf, MD; José Berrocal, MD; Raúl Pérez, MD; A. Ramos Umpierre, MD; James L. Kinyoun, MD; Robert E. Kalina, MD; Craig G. Wells, MD; Steven V. Guzak, MD; Jerry Palmer, MD; Frank L. Myers, MD; George H. Bresnick, MD; Suresh R. Chandra, MD; Matthew D. Davis, MD; Ronald Klein, MD; Thomas S. Stevens, MD; Ingolf H. Wallow, MD; Russell Dixon, MD; Edward Ehrlich, MD; Robin Ewart, MD; Robert N. Frank, MD; Stephenie Lucas, MD; Fred Whitehouse, MD; Harold Weiss, MD; Ann E. Ballen, MD; Michael Teske, MD; Maria Warth, MD; William E. Benson, MD; William S. Tasman, MD; Gary C. Brown, MD; J. Archibald McNamara, MD; Hunter L. Little, MD; Robert L. Jack, MD; Lawrence Basso, MD; Dayton T. Miller, PhD; Elaine Gunter; David D. Bayse, PhD; W. Harry Hannon, PhD; James E. Myrick, PhD; Genell L. Knatterud, PhD; Marian R. Fisher, PhD; Mary Jane Prior, PhD; Franca Barton, MS; Joseph Kufera, MA; Thomas W. Miller, MS; James K. Hooper, MS; Richard S. Crow, MD; Richard R. Baker, MD; Ronald Prineas, MBBS, PhD; Larry D. Hubbard, MAT; Yvonne L. Magli; Paul Segal, MD; Richard L. Mowery, PhD; Emily Y. Chew, MD; Daniel G. Seigel, ScD; Gary Cassel, MD
Author Affiliations

Albany (NY) Medical College; Eye Research Institute of Retina Foundation/Retina Associates, Boston, Mass.; Good Samaritan Hospital and Medical Center, Portland, Ore; Hermann Eye Center, University of Texas, Houston; Holy Cross Hospital, Salt Lake City, Utah; Ingalls Memorial Hospital, Harvey, III; Johns Hopkins Hospital (Wilmer Institute), Baltimore, Md.; Joslin Diabetes Center (Beetham Eye Institute), Boston, Mass.; Louisiana State University Eye Center, New Orleans; Medical College of Wisconsin, Milwaukee; Michigan State University (Associated Retinal Consultants), East Lansing; Pacific Presbyterian Medical Center, San Francisco, Calif.; UCLA Center for Health Sciences (Jules Stein Eye Institute), Los Angeles, Calif.; University of Illinois, Chicago; University of Miami, Fla (Bascom Palmer Eye Institute); University of Minnesota, Minneapolis; University of Puerto Rico, Rio Piedras; University of Washington, Seattle; University of Wisconsin, Madison; Wayne State University (Kresge Eye Institute), Detroit, Mich.; Wills Eye Hospital, Philadelphia, Pa; Zweng Memorial Retinal Research Foundation, Menlo Park, Calif.; Central Laboratory (Centers for Disease Control, Atlanta, Ga); Coordinating Center (Maryland Medical Research Institute, Baltimore); Drug Distribution Center (US Public Health Service, Perry Point, Md); ECG Coding Center (University of Minnesota, Minneapolis); Fundus Photograph Reading Center (University of Wisconsin, Madison); National Eye Institute, National Institutes of Health, Bethesda, Md.

JAMA. 1992;268(10):1292-1300. doi:10.1001/jama.1992.03490100090033

Objectives.  —This report presents information on the effects of aspirin on mortality, the occurrence of cardiovascular events, and the incidence of kidney disease in the patients enrolled in the Early Treatment Diabetic Retinopathy Study (ETDRS).

Study Design.  —This multicenter, randomized clinical trial of aspirin vs placebo was sponsored by the National Eye Institute.

Patients.  —Patients (N=3711) were enrolled in 22 clinical centers between April 1980 and July 1985. Men and women between the ages of 18 and 70 years with a clinical diagnosis of diabetes mellitus were eligible. Approximately 30% of all patients were considered to have type I diabetes mellitus, 31% type II, and in 39% type I or II could not be determined definitely.

Intervention.  —Patients were randomly assigned to aspirin or placebo (two 325-mg tablets once per day).

Main Outcome Measures.  —Mortality from all causes was specified as the primary outcome measure for assessing the systemic effects of aspirin. Other outcome variables included cause-specific mortality and cardiovascular events.

Results.  —The estimate of relative risk for total mortality for aspirin-treated patients compared with placebo-treated patients for the entire study period was 0.91 (99% confidence interval, 0.75 to 1.11). Larger differences were noted for the occurrence of fatal and nonfatal myocardial infarction; the estimate of relative risk was 0.83 for the entire follow-up period (99% confidence interval, 0.66 to 1.04).

Conclusions.  —The effects of aspirin on any of the cardiovascular events considered in the ETDRS were not substantially different from the effects observed in other studies that included mainly nondiabetic persons. Furthermore, there was no evidence of harmful effects of aspirin. Aspirin has been recommended previously for persons at risk for cardiovascular disease. The ETDRS results support application of this recommendation to those persons with diabetes at increased risk of cardiovascular disease.(JAMA. 1992;268:1292-1300)