Low-Dose Aspirin Shows Cardiovascular Benefits for High-Risk Type 2 Diabetes Patients
A preliminary study suggests adults with Type 2 diabetes and moderate-to-high cardiovascular risk who take low-dose aspirin experience significantly lower rates of heart attack, stroke, and death compared to non-users, though bleeding risks require careful consideration.
Adults with Type 2 diabetes and moderate or high cardiovascular disease risk who took low-dose aspirin experienced substantially lower rates of serious 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 from this preliminary study suggest that consistent low-dose aspirin use may offer significant cardiovascular protection for this specific high-risk population.
The analysis of electronic health records from more than 11,500 adults with Type 2 diabetes revealed striking differences in cardiovascular outcomes over a 10-year period. Participants who took low-dose aspirin showed a 42.4% rate of heart attack compared to 61.2% among non-users. Similarly, stroke risk was substantially lower in the aspirin group (14.5% versus 24.8%), and death from any cause within 10 years was reduced to 33% compared to 50.7% in those not taking aspirin.
"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 study classified aspirin use based on frequency noted in medical records over approximately eight years of follow-up, ranging from no use to frequent use (more than 70% of the time). Researchers found that any low-dose aspirin use was associated with reduced risk of heart attack and stroke, with the greatest benefit observed among those who took aspirin most consistently. The analysis also indicated that better blood sugar control, as measured by lower HbA1c levels, appeared to enhance the cardiovascular benefits of aspirin therapy.
However, the study carries important limitations and considerations. The research excluded individuals with high bleeding risk and did not track bleeding events, a crucial factor given aspirin's known bleeding complications. As noted in the American Heart Association's 2019 Guideline on the Primary Prevention of Cardiovascular Disease, bleeding risk assessment is essential when considering aspirin therapy. The observational nature of the study means the findings cannot prove causation, and medication adherence was based on medical record documentation rather than direct monitoring.
Cardiovascular disease remains the leading cause of death among people with Type 2 diabetes, and Type 2 diabetes itself is a major risk factor contributing to the recent rise in heart disease and stroke. According to the American Heart Association's 2025 Heart Disease and Stroke Statistics, more than half of all U.S. adults have Type 2 diabetes or pre-diabetes, highlighting the public health significance of these findings.
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. "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," said Amit Khera, M.D., M.Sc., FAHA, volunteer chair of the American Heart Association's Advocacy Coordinating Committee.
Researchers emphasized the need for further investigation into balancing aspirin's cardiovascular benefits against bleeding risks, particularly for high-risk individuals, and exploring how aspirin might interact with emerging diabetes and heart disease therapies such as GLP-1 medications. The study abstract is available through the American Heart Association's Scientific Sessions 2025 Online Program Planner.