For years, the medical community has sought the ideal balance for aspirin in primary prevention. New evidence from the American Heart Association (AHA) Scientific Sessions 2025 highlights a significant opportunity for a specific group of patients—those with Type 2 Diabetes (T2D) and moderate-to-high cardiovascular risk—to achieve substantial health gains through consistent aspirin use. [1,2]
This comprehensive analysis of over 11,000 patients revealed significant reductions in clinical events in the aspirin (ASA) group and the No ASA group over a 10-year time course:
- Heart Attack (MI): Cumulative incidence was significantly lower in the ASA group at 42.4% vs. 61.2% (p<0.001).
- Ischemic Stroke: Incidence was reduced to 14.5% in the ASA group compared to 24.8% in the No ASA group (p<0.001).
- Longevity: 10-year all-cause mortality was significantly lower in the ASA group at 33.0% compared to 50.7% (p<0.001).
A “dose-dependent” effect was observed, with the high-adherence (≥70% adherence) group deriving the greatest benefits (58% reduction in the risk of heart attack and revascularization) and a 47% reduction in all-cause mortality.
Synergy with Metabolic Health
The study further emphasizes that aspirin complements overall diabetes management. While benefits were observed across the board, the most profound risk reductions occurred in patients with well-controlled blood sugar (lower HbA1c). This suggests that aspirin acts as a powerful partner to a healthy lifestyle and effective glycemic control, magnifying the protective effects for the heart and brain. [1,2]
Table 1: Multivariable-adjusted* hazard ratio (HR) for readmission and all-cause mortality comparing ASA vs no ASA stratified by HbA1c |
| 6.5≤HbA1c≤7 | 7≤9 | HbA1c>9 |
| HR (95% CI) | P-Value | HR (95% CI) | P-Value | HR (95% CI) | P-Value |
MI/Revase | 0.49 (0.44-056) | <0.001 | 0.48 (0.44-0.540 | <0.001 | 0.65 (0.58-0.73)a | <0.001 |
I-Stroke | 0.54 (0.43-0.69) | <0.001 | 0.44 (0.36-0.54) | <0.001 | 0.49 (0.40-0.59) | <0.001 |
All-Cause Mortality | 0.61 (0.51-0.72) | <0.001 | 0.46 (0.40-0.53)b | <0.001 | 0.66 (0.56-0.79)c | <0.001 |
a p<0.001 comparing with A1C 6.5; A1C <7 and 7< A1C ≤ 9 group b p<0.001 comparing with A1C 6.5; A1C <7 and 7< A1C > 9 group c p<0.05 comparing with A1C 6.5; A1C <7 Abbreviations: Abbreviations: ASA=aspirin; CI=confidence interval; HbA1c = hemoglobin A1c; HR=Hazard ratio; revac= revascularization *Models were adjusted for the variables of the pooled cohort equations (age, sex, race, diabetes, hypertension, smoking, systolic blood pressure, total and high-density lipoprotein cholesterol levels) as well as statin use. |
A Tailored Path Forward
Modern medicine is shifting toward precision prevention. Current guidelines, including the DCRM 2.0 (2024) and USPSTF (2022), support the use of aspirin for adults with elevated cardiovascular risk factors such as hypertension, CKD, or a family history of heart disease. [3,4]
By identifying patients who stand to benefit most—specifically those with T2D and a low risk for complications—clinicians can confidently utilize aspirin as a cornerstone of cardiovascular health.
Disclaimer: This website is primarily for healthcare professionals. The content here does not replace medical advice and should not be used as medical, diagnostic, endorsement, treatment, or prescription advice. Medical science evolves rapidly, and we strive to keep our information current. If you find any discrepancies, please contact us at corrections@medicaldialogues.in. Read our Correction Policy here. Nothing here should be used as a substitute for medical advice, diagnosis, or treatment. We do not endorse any healthcare advice that contradicts a physician's guidance. Use of this site is subject to our Terms of Use, Privacy Policy, and Advertisement Policy. For more details, read our Full Disclaimer here.
NOTE: Join us in combating medical misinformation. If you encounter a questionable health, medical, or medical education claim, email us at factcheck@medicaldialogues.in for evaluation.