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 findings, while preliminary, offer important insights for a population where cardiovascular disease remains the leading cause of death.
The study analyzed 10 years of electronic health record data from 11,681 adults with Type 2 diabetes who had moderate or high risk scores as determined by the 10-year Atherosclerotic Cardiovascular Disease (ASCVD) 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 had an average age of 61.6 years, with 46.24% female and 53.76% male representation.
Researchers found striking differences in cardiovascular outcomes between aspirin users and non-users. 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 non-users. The risk of stroke was also substantially lower 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 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 dose-dependent, with greater protection observed among those who took low-dose aspirin most consistently throughout the approximately eight-year follow-up period. Any low-dose aspirin use was associated with reduced risk of heart attack and stroke, but the greatest benefit was seen among those who took low-dose aspirin more than 70% of the time.
An important finding emerged regarding diabetes management. Low-dose aspirin use was associated with similarly lower risk of cardiovascular events regardless of participants' HbA1c levels, though the reduction was more substantial in individuals with better-controlled diabetes. This suggests that while aspirin provides cardiovascular protection across different levels of blood sugar control, optimal diabetes management may enhance its benefits.
The study's limitations warrant careful consideration. As an observational analysis of real-world data rather than a clinical trial, the findings cannot prove causation. The research also excluded people with high bleeding risk and did not track bleeding events, which is significant given aspirin's known bleeding complications. Low-dose aspirin use was measured based on medication lists in health records, which may not accurately reflect actual usage patterns.
Current American Heart Association guidelines reflect cautious approaches to aspirin for primary prevention. The Association's 2019 Guideline on the Primary Prevention of Cardiovascular Disease states that daily low-dose aspirin might be considered in select adults 40-70 years of age at higher heart disease risk but not increased bleeding risk. However, the Association does not currently recommend low-dose aspirin for primary prevention of cardiovascular disease for adults with Type 2 diabetes who have no history of cardiovascular disease.
"This study offers some interesting insights into helping reduce the incidence of major cardiovascular events among people with Type 2 diabetes," said Amit Khera, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association's Advocacy Coordinating Committee. "This is very important because cardiovascular disease continues to be the leading cause of death among people with Type 2 diabetes, and furthermore, Type 2 diabetes is a leading risk factor contributing to a recent rise in heart disease and stroke."
The research highlights the complex balance between cardiovascular benefits and bleeding risks that must be carefully evaluated for each individual. 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 this research particularly relevant to public health. The findings suggest that for carefully selected individuals with Type 2 diabetes and elevated cardiovascular risk, low-dose aspirin may offer meaningful protection against life-threatening cardiovascular events.
