Association between metformin, aspirin and cancer incidence and mortality risk in adults with diabetes

Suzanne G Orchard; Jessica E Lockery; Jonathan C Broder; Michael E Ernst; Sara Espinoza; Peter Gibbs; Rory Wolfe; Galina Polekhina; Sophia Zoungas; Holli A Loomans-Kropp; Robyn L Woods; ASPREE Investigator Group

doi:10.1093/jncics/pkad017

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Association between metformin, aspirin and cancer incidence and mortality risk in adults with diabetes

Journal article

Open access

Peer reviewed

Association between metformin, aspirin and cancer incidence and mortality risk in adults with diabetes

Suzanne G Orchard, Jessica E Lockery, Jonathan C Broder, Michael E Ernst, Sara Espinoza, Peter Gibbs, Rory Wolfe, Galina Polekhina, Sophia Zoungas, Holli A Loomans-Kropp, …

JNCI cancer spectrum, Vol.7(2), pkad017

04/2023

DOI: 10.1093/jncics/pkad017

PMCID: PMC10042437

PMID: 36857596

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Abstract

Metformin and aspirin are commonly co-prescribed to people with diabetes. Metformin may prevent cancer but, in older people, aspirin has been found to increase cancer mortality. This study examined if metformin reduces cancer mortality and incidence in older people with diabetes, and utilized randomization to 100 mg aspirin or placebo in the ASPREE trial to quantify aspirin's impact within metformin users. Analysis included community-dwelling ASPREE participants (70+ years, or ≥ 65 years for U.S. minorities) with diabetes. Diabetes was defined as fasting blood glucose level (FBGL) >125mg/DL, self-report of diabetes or antidiabetic medication use. Cox proportional hazards regression models were used to analyze the association of metformin, and a metformin and aspirin interaction, with cancer incidence and mortality with adjustment for confounders. Of 2045 participants with diabetes at enrollment, 965 were concurrently using metformin. Metformin was associated with a reduced cancer incidence risk (Adjusted HR = 0.68, 95% CI 0.51, 0.90), but no conclusive benefit for cancer mortality (Adjusted HR = 0.72, 95%CI 0.43, 1.19). Metformin users randomized to aspirin had greater risk of cancer mortality compared to placebo (HR = 2.53, 95% CI 1.18, 5.43), but no effect was seen for cancer incidence (HR = 1.11, 95% CI 0.75, 1.64). However, the possible effect modification of aspirin on cancer mortality was not statistically significant (interaction P = .11). In community-dwelling older adults with diabetes, metformin use was associated with reduced cancer incidence. Increased cancer mortality risk in metformin users randomized to aspirin warrants further investigation. Clinicaltrials.gov number, NCT01038583.

older adults

aspirin

metformin

cancer

ASPREE clinical trial

Details

Title: Subtitle: Association between metformin, aspirin and cancer incidence and mortality risk in adults with diabetes
Creators: Suzanne G Orchard - Monash University
Jessica E Lockery - RMIT University
Jonathan C Broder - Monash University
Michael E Ernst - University of Iowa
Sara Espinoza - The University of Texas Health Science Center
Peter Gibbs - Walter and Eliza Hall Institute of Medical Research
Rory Wolfe - Monash University
Galina Polekhina - Monash University
Sophia Zoungas - Monash University
Holli A Loomans-Kropp - The Ohio State University
Robyn L Woods - Monash University
ASPREE Investigator Group
Resource Type: Journal article
Publication Details: JNCI cancer spectrum, Vol.7(2), pkad017
DOI: 10.1093/jncics/pkad017
PMID: 36857596
PMCID: PMC10042437
NLM abbreviation: JNCI Cancer Spectr
eISSN: 2515-5091
Grant note: DOI: 10.13039/100000049, name: National Institute on Aging; DOI: 10.13039/100000002, name: National Institutes of Health
Language: English
Electronic publication date: 03/01/2023
Date published: 04/2023
Academic Unit: Family and Community Medicine; Pharmacy Practice and Science
Record Identifier: 9984375448902771

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