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

Adults with Type 2 diabetes and moderate or high risk of cardiovascular disease who took low-dose aspirin were less likely to experience serious cardiovascular events including heart attack, stroke, or death than peers who did not take aspirin, according to research to be presented at the American Heart Association's Scientific Sessions 2025. The analysis of electronic health record data spanning 10 years involved more than 11,500 adults with Type 2 diabetes who had moderate or high cardiovascular risk scores as determined by the 10-year Atherosclerotic Cardiovascular Disease risk calculator outlined in a 2018 special report from the American Heart Association and the American College of Cardiology.

Researchers found that adults with Type 2 diabetes who took low-dose aspirin were 42.4% less likely to have a heart attack compared to 61.2% among participants who did not take low-dose aspirin. The risk of stroke was also significantly lower at 14.5% in the aspirin group versus 24.8% in the no aspirin group, while the risk of death from any cause within 10 years was 33% for aspirin users compared to 50.7% for non-users. Any low-dose aspirin use among participants was linked to reduced risk of heart attack and stroke, with the greatest benefit observed among those who took low-dose aspirin most frequently throughout the approximately eight-year follow-up period.

The study's corresponding author Aleesha Kainat, M.D., a clinical assistant professor of medicine at the University of Pittsburgh Medical Center, noted the magnitude of the findings was somewhat surprising. People with Type 2 diabetes and higher cardiovascular risk who reported taking low-dose aspirin were much less likely to have experienced heart attack, stroke, or death over 10 years compared to similar individuals who did not report taking low-dose aspirin. The benefit was most pronounced for those who took aspirin consistently during most of the follow-up time.

In subgroup analyses, low-dose aspirin use was associated with similarly lower risk of cardiovascular events regardless of participants' HbA1c levels, though this reduction was more substantial in individuals who had lower HbA1c levels, indicating their Type 2 diabetes was better controlled. However, researchers emphasized important limitations, including that the analysis excluded people with high bleeding risk and did not track bleeding events or other side effects. Aspirin's bleeding risk remains crucial in real-life decision making, and individual bleeding risk must be accounted for when prescribing any medication.

The study's observational nature means researchers examined past, real-world data from patient records rather than enrolling participants in a clinical trial, so the findings cannot prove low-dose aspirin prevented or reduced major cardiovascular events. Additionally, low-dose aspirin use was measured based on reports within health records, which may not accurately reflect actual medication adherence or account for other unreported over-the-counter medications. There may have been other unidentified differences across groups that could influence the findings.

Amit Khera, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association's Advocacy Coordinating Committee, noted that while the American Heart Association does not currently recommend low-dose aspirin for primary prevention of cardiovascular disease for adults with Type 2 diabetes with no history of cardiovascular disease, this study raises important questions for further research. The clear message remains that individuals should work directly with their health care team to identify specific risk factors and conditions and together decide whether treatment benefits outweigh potential risks.

According to the American Heart Association's 2025 Heart Disease and Stroke Statistics, more than half of all adults in the U.S. have Type 2 diabetes or pre-diabetes, making cardiovascular risk management in this population particularly important. While low-dose aspirin is recommended for secondary prevention in guidelines such as the Association's 2025 Guideline for the Management of Patients With Acute Coronary Syndromes for adults who have already had cardiac events, its role in primary prevention requires careful individual assessment balancing potential cardiovascular benefits against bleeding risks.