Low-Dose Aspirin Linked to Lower Cardiovascular Risk in Type 2 Diabetes

Patients with type 2 diabetes (T2D) and an increased risk for cardiovascular disease (CVD) treated with low-dose aspirin were less likely to experience heart attack, stroke, or death. The data are to be presented at the American Heart Association Scientific Sessions 2025 in New Orleans.

Although recent research has questioned the benefit of aspirin for primary prevention in the general population without established CVD, T2D remains a well-known risk factor for heart disease and stroke. In this study, researchers investigated whether low-dose aspirin could reduce cardiovascular events, including heart attack, stroke, or death, among adults with T2D who are at elevated cardiovascular risk.

“We know that in recent studies aspirin hasn’t proven beneficial for primary prevention in people who don’t have established cardiovascular disease. However, T2D is a known risk factor for cardiovascular disease,” Aleesha Kainat, MD, a clinical assistant professor of medicine at the University of Pittsburgh Medical Center, said in a news release. “In our study, we wanted to better understand low-dose aspirin use in this very niche group of adults with T2D and with a moderate-to-high risk of cardiovascular disease—so, a population group who may or may not have been included in previous trials.”

The research team analyzed 10 years of electronic health records for 11,681 adults with T2D and a moderate-to-high 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Participants were drawn from the University of Pittsburgh Medical Center system, encompassing over 35 hospitals and 400 outpatient clinics across Pennsylvania, Maryland, and West Virginia. Individuals with a high bleeding risk were excluded.

Aspirin use was categorized based on frequency documented in medical records: no use, seldom use (less than 30% of follow-up), sometimes used (30%—69%), and frequent use (over 70%). Researchers also considered whether participants had controlled blood glucose levels (HbA1c) and adherence to prescribed medications, including statins. The study assessed cardiovascular outcomes, including heart attack, stroke, and death, over a 10-year period.

The analysis found that participants who took low-dose aspirin had significantly lower rates of cardiovascular events compared with those who did not. Heart attack occurred in 42.4% of aspirin users versus 61.2% of non-users, while stroke affected 14.5% of aspirin users compared to 24.8% of non-users. All-cause mortality was also lower among aspirin users (33% versus 50.7%). The greatest benefit was seen among individuals who consistently took aspirin throughout the follow-up period.

Subgroup analyses revealed that the protective effect of aspirin was observed regardless of HbA1c levels, although benefits were more pronounced in participants with better-controlled diabetes. Researchers emphasized that bleeding risk was not assessed in this study, which remains a key consideration in clinical decision-making.

“We were somewhat surprised by the magnitude of the findings,” Kainat said. “People with T2D 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. That benefit was greatest for those who took aspirin consistently throughout most of the follow-up time.”

For pharmacists, these findings highlight the importance of individualized medication counseling and risk assessment for patients with T2D. Pharmacists are well positioned to review patient records for cardiovascular risk factors, monitor adherence to low-dose aspirin and other cardioprotective therapies, and educate patients on the potential benefits and bleeding risks of aspirin use.

REFERENCES

Low-dose aspirin linked to lower cardiovascular event risk for adults with Type 2 diabetes. News Release. November 3, 2025. Accessed November 5, 2025. https://www.eurekalert.org/news-releases/1103670