Research Highlights:
- Adults with Type 2 diabetes (T2D) and at moderate or high risk of cardiovascular disease who took low-dose aspirin were less likely to experience a serious cardiovascular event, including a heart attack, stroke or death, than peers who did not take aspirin.
- Any low-dose aspirin use was associated with significantly lower risk of having a heart attack or stroke compared to no low-dose aspirin use, with greater benefit observed among those individuals who took it the most often.
- Low-dose aspirin use was associated with similarly lower risks of a cardiovascular event for people with T2D no matter their blood sugar levels, though this reduction was more substantial in individuals who had lower HBA1c levels, indicating their T2D was better controlled.
- Note: The study featured in this news release is a research abstract. Abstracts presented at American Heart Association's scientific meetings are not peer-reviewed, and the findings are considered preliminary until published as full manuscripts in a peer-reviewed scientific journal.
Embargoed until 4 a.m. CT/5 a.m. ET, Monday, Nov. 3, 2025
DALLAS, Nov. 3, 2025 — People with Type 2 diabetes (T2D) and an elevated risk for cardiovascular disease (CVD) who took low-dose aspirin were less likely to experience a major cardiovascular event, including heart attack, stroke or death, than people with T2D at similar CVD risk who did not take low-dose aspirin, according to a preliminary study to be presented at the American Heart Association's Scientific Sessions 2025. The meeting, Nov. 7-10, in New Orleans, is a premier global exchange of the latest scientific advancements, research and evidence-based clinical practice updates in cardiovascular science.
"We know that in recent studies aspirin hasn't proven beneficial for primary prevention in people who don't have established cardiovascular disease. However, Type 2 diabetes is a known risk factor for cardiovascular disease," said corresponding study author Aleesha Kainat, M.D., a clinical assistant professor of medicine at the University of Pittsburgh Medical Center. "In our study, we wanted to better understand low-dose aspirin use in this very niche group of adults with Type 2 diabetes 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."
For this study, researchers analyzed 10 years of electronic health record data on more than 11,500 adults. The individuals were previously diagnosed with Type 2 diabetes and had a moderate or high risk for a cardiovascular event. Additionally, the researchers reviewed the potential effects of whether individuals had their blood glucose levels under control, along with whether they took medications as prescribed more frequently.
"We were somewhat surprised by the magnitude of the findings," Kainat said. "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. That benefit was greatest for those who took aspirin consistently, throughout most of the follow-up time."
The analysis found:
- Adults with Type 2 diabetes who took low-dose aspirin were less likely to have a heart attack (42.4%) than the participants who did not take low-dose aspirin (61.2%).
- For those on a low-dose aspirin regimen, the risk of stroke was also lower (14.5% aspirin group vs. 24.8% no aspirin group), as was the risk of death from any cause within 10 years (33% aspirin group compared to 50.7% no aspirin group).
- Any low-dose aspirin use among the participants was linked to reduced risk of heart attack and stroke, with the greatest benefit seen among those who took low-dose aspirin most frequently.
- In subgroup analyses, low-dose aspirin use was associated with similarly lower risk of a cardiovascular event no matter the participant's HBA1c, or blood glucose, levels, though this reduction was more substantial in individuals who had lower HBA1c levels, indicating their T2D was better controlled
"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," said Kainat. "That's an important limitation because aspirin's bleeding risk is crucial in real-life decision making and a person's independent bleeding risk has to be accounted for whenever we are prescribing a medication."
"This study offers some interesting insights into helping reduce the incidence of major cardiovascular events among people with Type 2 diabetes. 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," said Amit Khera, M.D., M.Sc., FAHA, the volunteer chair of the American Heart Association's Advocacy Coordinating Committee and recipient of the Association's 2025 Chairman's Award. "While the American Heart 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 raises some good questions for further research and validation. 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." Khera, who was not involved in this study, is a professor of medicine, clinical chief of cardiology and director of preventive cardiology at UT Southwestern Medical Center in Dallas
The study had additional limitations. The analysis was observational, meaning the researchers examined past, real-world data from patient records rather than enrolling participants in a clinical trial. The findings cannot prove low-dose aspirin prevented or reduced major cardiovascular event. Also, the researchers measured low-dose aspirin use based on reports within individuals' health records, which may not accurately reflect how often people actually took low-dose aspirin or if they took other unreported over-the-counter medications. Additionally, there may have been other unidentified differences across the groups of individuals who took low-dose aspirin versus those who did not, which could influence the findings.
"We'll need to look at how we balance the cardiovascular benefits of low-dose aspirin with its known bleeding risks for individual high-risk individuals, such as those who have high inflammatory burden or subclinical coronary calcifications," Kainat said. "It is also an open area of inquiry to see how low-dose aspirin's benefit might interact with the myriad of emerging therapies for Type 2 diabetes and heart disease, such as GLP-1 medications and other lipid lowering agents besides statins, so we look forward to conducting more research on this important topic."
Study details, background and design:
- Low-dose aspirin use among the participants was based on how frequently it was noted on the medication list of their medical records over the follow-up period of about eight years. It was classified as: no use, seldom use (<30% of the time), sometimes used (between 30-70% of the time) and frequently used (>70% of the time).
- The study included health records for 11,681 adults with Type 2 diabetes who had a moderate or high risk score 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 . All records were from a primary prevention registry within the University of Pittsburgh Medical Center multihospital system, which includes over 35 hospitals and 400 outpatient clinics in Pennsylvania, Maryland and West Virginia.
- Participants had an average age of 61.6 years, 46.24% were female and 53.76% were male. People who were at a higher risk for bleeding were excluded.
- Participants were divided into four groups, depending on how often their medical records noted they took low-dose aspirin over the course of about eight years of follow-up: no low-dose aspirin, low-dose aspirin taken less than 30% of the time, low-dose aspirin taken 30-69% of the time and low-dose aspirin taken more than 70% of the time.
- The analyses compared the incidence of stroke, heart attack and death from any cause within 10 years across all four participant groups.
- Across the study's 10-year follow-up, 88.6% of all participants reported taking low-dose aspirin and 53.15% reported taking statins, or cholesterol-lowering medications.
- An additional analysis investigated potential links between low-dose aspirin use and heart attack, stroke and death based on participants' levels of blood sugar, or HbA1C results.
Heart attack and stroke are leading causes of death in the U.S., and people with Type 2 diabetes are at increased risk for these events . According to the American Heart Association's 2025 Heart Disease and Stroke Statistics , more than half (57%) of all adults in the U.S. have Type 2 diabetes or pre-diabetes.
Aspirin is a blood-thinning medication and is often used in low doses to reduce CVD risk. Low-dose aspirin is recommended for secondary prevention in the American Heart Association's 2025 Guideline for the Management of Patients With Acute Coronary Syndrome for adults who have already had a cardiac event and in the Association's 2021 Guideline for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack for adults who have already had a stroke. However, 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 who are at higher risk for heart disease but not at increased bleeding risk. The Association's 2024 Guideline for the Primary Prevention of Stroke states that in people with diabetes or other common vascular risk factors and no prior stroke, the use of aspirin to prevent a first stroke is not well established.
Co-authors, disclosures and funding sources are listed in the abstract.
Statements and conclusions of studies that are presented at the American Heart Association's scientific meetings are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association's scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.
