Low-Dose Aspirin Shows Cardiovascular Benefits for High-Risk Type 2 Diabetes Patients

Adults with Type 2 diabetes and elevated cardiovascular disease risk who took low-dose aspirin experienced substantially lower rates of major cardiovascular events including heart attack, stroke, and 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 findings, while preliminary, suggest potential benefits for a population at particularly high risk for cardiovascular complications.

The study analyzed electronic health records of 11,681 adults with Type 2 diabetes and moderate-to-high cardiovascular risk over approximately eight years. Participants who reported taking low-dose aspirin showed a 42.4% incidence of heart attack compared to 61.2% among non-users. Stroke risk was similarly reduced at 14.5% for aspirin users versus 24.8% for non-users, while death from any cause within 10 years occurred in 33% of aspirin users compared to 50.7% of non-users.

"We were somewhat surprised by the magnitude of the findings," said corresponding author Dr. Aleesha Kainat, clinical assistant professor of medicine at the University of Pittsburgh Medical Center. "People with Type 2 diabetes and a higher risk of CVD who reported taking low-dose aspirin were much less likely to have had a heart attack, stroke or death over 10 years when compared to similar individuals who did not report taking low-dose aspirin."

The cardiovascular benefit appeared strongest among those who took aspirin most consistently throughout the follow-up period. The study classified aspirin use based on frequency noted in medical records: no use, seldom use (less than 30% of the time), sometimes used (30-70% of the time), and frequently used (more than 70% of the time).

An important finding emerged regarding diabetes management. Low-dose aspirin use was associated with similarly lower cardiovascular risk regardless of participants' HbA1c levels, though the reduction was more substantial in individuals with better-controlled diabetes. This suggests that aspirin's benefits may complement good diabetes management rather than substitute for it.

The study used the 10-year Atherosclerotic Cardiovascular Disease risk score outlined in a 2018 special report from the American Heart Association and the American College of Cardiology to identify moderate and high-risk participants. All records came from a primary prevention registry within the University of Pittsburgh Medical Center multihospital system.

However, researchers emphasized significant limitations. The analysis excluded people with high bleeding risk and did not track bleeding events or other side effects. "Aspirin's bleeding risk is crucial in real-life decision making and a person's independent bleeding risk has to be accounted for whenever we are prescribing a medication," Kainat noted.

The study's observational nature means it cannot prove causation, and medication use was based on health record documentation rather than direct observation. Additionally, there may have been other unidentified differences between aspirin users and non-users that influenced the results.

Dr. Amit Khera, volunteer chair of the American Heart Association's Advocacy Coordinating Committee, highlighted the study's importance given that cardiovascular disease remains the leading cause of death among people with Type 2 diabetes. "This study offers some interesting insights into helping reduce the incidence of major cardiovascular events among people with Type 2 diabetes," said Khera, who was not involved in the research.

Current American Heart Association guidelines, including the 2019 Guideline on the Primary Prevention of Cardiovascular Disease, do not recommend low-dose aspirin for primary prevention in adults with Type 2 diabetes who have no history of cardiovascular disease. The Association's 2024 Guideline for the Primary Prevention of Stroke states that aspirin use to prevent first strokes in people with diabetes is not well established.

Researchers plan to investigate how low-dose aspirin's benefits interact with emerging diabetes and heart disease therapies, including GLP-1 medications and other lipid-lowering agents. The findings will require validation through peer-reviewed publication and additional research before clinical recommendations might change.