Although findings have been mixed, overall results suggest that aspirin modestly reduces the risk of cardiovascular events in adults with diabetes.

In a joint statement (authored by Michael Pignone, MD, and colleagues and published online on May 27), the American College of Cardiology Foundation, American Diabetes Association (ADA), and American Heart Association (AHA) updated their recommendations for primary-prevention aspirin use in people with diabetes.

In 2007, the ADA and AHA recommended low-dose aspirin therapy (75-162 mg/day) for men and women over age 40 years with at least one of the following major risk factors: smoking, hypertension, dyslipidemia, family history of premature CVD, or albuminuria. The updated recommendations take a more conservative approach:

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Low-dose aspirin use for primary prevention of cardiovascular events is reasonable for adults with diabetes and no history of vascular disease who are at increased risk of CVD (most men over age 50 years and most women over age 60 years who have at least one additional major risk factor and who are not at increased risk for bleeding).

Aspirin for CVD prevention should not be recommended for adults with diabetes at low risk for CVD (men under age 50 years and women under age 60 years with no major additional CVD risk factors and a 10-year CVD risk under 5%).

Until more research is available, low-dose aspirin use for CVD primary prevention might be considered for those with diabetes at intermediate CVD risk (younger patients with at least one risk factor or older patients with no risk factors, or patients with a 10-year CVD risk of 5% to 10%).