Low-Dose Aspirin Associated with Reduced Cardiovascular Risk in Type 2 Diabetes Patients

Adults with Type 2 diabetes and moderate or high cardiovascular disease risk who took low-dose aspirin were significantly less likely to experience serious cardiovascular events including heart attack, stroke, or death compared to similar individuals who did not take aspirin, according to research to be presented at the American Heart Association's Scientific Sessions 2025. The study analyzed electronic health record data from more than 11,500 adults with Type 2 diabetes over a 10-year period, focusing specifically on individuals with elevated cardiovascular risk who may not have been adequately represented in previous aspirin trials.

The analysis revealed substantial differences in cardiovascular outcomes between aspirin users and non-users. Adults with Type 2 diabetes who took low-dose aspirin experienced heart attacks at a rate of 42.4% compared to 61.2% among those who did not take aspirin. Stroke risk was also significantly lower in the aspirin group at 14.5% versus 24.8% in the non-aspirin group. Most notably, the risk of death from any cause within 10 years was 33% for aspirin users compared to 50.7% for non-users.

Study author Aleesha Kainat, M.D., a clinical assistant professor of medicine at the University of Pittsburgh Medical Center, expressed surprise at the magnitude of the findings. The benefit was most pronounced among individuals who took aspirin consistently throughout the follow-up period, with any low-dose aspirin use associated with reduced risk of heart attack and stroke. The research utilized data from a primary prevention registry within the University of Pittsburgh Medical Center multihospital system, which includes over 35 hospitals and 400 outpatient clinics across Pennsylvania, Maryland, and West Virginia.

An important aspect of the study examined the relationship between blood sugar control and aspirin benefits. Low-dose aspirin use was associated with similarly lower cardiovascular event risks regardless of participants' HbA1c levels, though the reduction was more substantial in individuals with better-controlled diabetes. This finding suggests that diabetes management remains crucial even when considering aspirin therapy for cardiovascular protection.

The study employed the 10-year Atherosclerotic Cardiovascular Disease risk score, a standardized cardiovascular disease calculator outlined in a 2018 special report from the American Heart Association and the American College of Cardiology. Participants were categorized based on their aspirin usage patterns: no use, seldom use (less than 30% of the time), sometimes used (30-69% of the time), and frequently used (more than 70% of the time). During the 10-year follow-up, 88.6% of all participants reported taking low-dose aspirin while 53.15% reported taking statins.

Several limitations warrant consideration. The observational nature of the study means the findings cannot prove causation, and researchers relied on medication documentation in health records rather than direct monitoring of aspirin consumption. Importantly, the study excluded individuals with high bleeding risk and did not track bleeding events or other side effects. As Kainat noted, bleeding risk remains a crucial factor in real-world clinical decision-making when considering aspirin therapy.

Amit Khera, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association's Advocacy Coordinating Committee, emphasized the significance of these findings given that cardiovascular disease continues to be the leading cause of death among people with Type 2 diabetes. While the American Heart Association does not currently recommend low-dose aspirin for primary prevention of cardiovascular disease in adults with Type 2 diabetes who have no history of cardiovascular disease, this study raises important questions for future research. Current guidelines for aspirin use in cardiovascular prevention are detailed in the Association's 2019 Guideline on the Primary Prevention of Cardiovascular Disease and 2024 Guideline for the Primary Prevention of Stroke.

The implications of this research are substantial given that more than half of all adults in the United States have Type 2 diabetes or pre-diabetes, according to the American Heart Association's 2025 Heart Disease and Stroke Statistics. Future research directions include examining how low-dose aspirin benefits interact with emerging therapies for Type 2 diabetes and heart disease, such as GLP-1 medications and other lipid-lowering agents beyond statins. The findings highlight the need for personalized risk assessment and careful consideration of both benefits and bleeding risks when considering aspirin therapy for cardiovascular protection in high-risk diabetic populations.