Low-dose aspirin, once widely prescribed to prevent heart attacks and strokes, could still hold significant benefits for people living with type 2 diabetes, according to new research to be presented on November 9 at the American Heart Association’s (AHA) annual meeting in New Orleans.

The study, led by Dr. Aleesha Kainat, Clinical Assistant Professor of Medicine at the University of Pittsburgh Medical Center, found that adults with type 2 diabetes who regularly took low-dose aspirin were less likely to experience heart attacks, strokes, or death over a 10-year period compared to those who did not use the drug.

“We were somewhat surprised by the magnitude of the findings,” Dr. Kainat said. “People with type 2 diabetes and a higher risk of cardiovascular disease 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 take aspirin. The benefit was greatest for those who took aspirin consistently.”

The research team examined data from nearly 11,700 adults with type 2 diabetes and elevated cardiovascular risk across more than 35 hospitals and 400 outpatient clinics in Pennsylvania, Maryland, and West Virginia. Results revealed striking differences — heart attacks occurred in 42% of aspirin users versus 61% of non-users, while stroke rates were 15% compared to 25%, and overall mortality was 33% versus 51%, respectively.

For decades, aspirin had been a cornerstone in heart disease prevention. However, in 2022, the U.S. Preventive Services Task Force revised its guidelines, cautioning that the potential bleeding risks from aspirin’s blood-thinning effects might outweigh its preventive benefits in people without established heart disease.

Dr. Kainat noted that their findings could help refine aspirin use among people who fall into a unique category—those with type 2 diabetes but no prior cardiovascular events, who may still face heightened heart disease risks.

“It’s worth noting that our analysis excluded people with a high bleeding risk, and we did not track bleeding events or other side effects,” she emphasized. “That’s an important limitation, as a person’s individual bleeding risk must always be considered when prescribing aspirin.”

Commenting on the study, Dr. Amit Khera, Director of Preventive Cardiology at UT Southwestern Medical Center in Dallas and spokesperson for the AHA, said the findings were “very important” as cardiovascular disease remains the leading cause of death among people with type 2 diabetes.

“While the American Heart Association does not currently recommend low-dose aspirin for primary prevention in adults with type 2 diabetes who have no history of cardiovascular disease, this study raises good questions for further research and validation,” Dr. Khera said. “The key message is to work closely with your healthcare team to evaluate whether the benefits of aspirin outweigh its potential risks.”

Researchers emphasized that while the findings show a strong association between aspirin use and reduced cardiovascular events, they do not establish a direct cause-and-effect link. Future studies, they said, should explore how aspirin’s benefits compare or combine with emerging therapies for type 2 diabetes, such as GLP-1 receptor agonists and new lipid-lowering agents.

As the debate around aspirin’s preventive role continues, this research offers a promising insight: for people with type 2 diabetes, a low-dose daily aspirin regimen—under medical supervision—may still play a role in protecting the heart.