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 on those with elevated cardiovascular risk but excluding individuals with high bleeding risk.
The analysis revealed substantial differences in cardiovascular outcomes between aspirin users and non-users. Adults who took low-dose aspirin experienced a 42.4% rate of heart attack compared to 61.2% among non-users. Stroke risk was also significantly lower in the aspirin group at 14.5% versus 24.8% in the non-aspirin group. Mortality from any cause within 10 years was 33% for aspirin users compared to 50.7% for non-users. "We were somewhat surprised by the magnitude of the findings," said corresponding study author Aleesha Kainat, M.D., a 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 benefit appeared to be dose-dependent, with greater cardiovascular protection observed among individuals who took low-dose aspirin most consistently throughout the approximately eight-year 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 protective effects may be enhanced when combined with effective blood sugar management.
The study utilized 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 participants with moderate or high cardiovascular risk. All records came from a primary prevention registry within the University of Pittsburgh Medical Center multihospital system. Despite the promising findings, researchers emphasized important limitations. "It's worth noting that our analysis excluded the records of people who had a high risk of bleeding, and we did not track bleeding events or other side effects in our study," Kainat explained. "That's an important limitation because aspirin's bleeding risk is crucial in real-life decision making."
The American Heart Association currently does not recommend low-dose aspirin for primary prevention of cardiovascular disease in adults with Type 2 diabetes who have no history of cardiovascular disease. Amit Khera, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association's Advocacy Coordinating Committee, noted that while the study raises important questions, "the clear message is to always work directly with your health care team to identify your specific risk factors and conditions and together decide whether the benefits of any treatment outweigh the potential risks." As heart disease remains the leading cause of death among people with Type 2 diabetes, and with more than half of American adults having Type 2 diabetes or pre-diabetes according to the American Heart Association's 2025 Heart Disease and Stroke Statistics, this research highlights the need for personalized approaches to cardiovascular prevention in this high-risk population. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
