The following are key points to remember about aspirin for primary cardiovascular disease (CVD) risk prevention in diabetes mellitus (DM):

1. Among patients with documented CVD, strong evidence exists for the benefits of aspirin. However, its benefit for primary prevention is less clear. A modest benefit has been observed, but at an increased risk for intracranial and gastrointestinal bleeding.
2. Patients with DM are at increased risk for CVD; however, the sole presence of DM does not appear to be sufficient to recommend aspirin to all DM patients. Given the projected increase in DM (an estimated 366 million adults by 2030), research on the risk–benefit of aspirin among diabetes is warranted.
3. If prescribed for primary prevention, aspirin should be at the lowest dose possible (such as 75-100 mg). The authors recommend uncoated aspirin with higher bioavailability – but with concurrent use of a proton-pump inhibitor for patients at high risk for bleeding.
4. Among those who are prescribed aspirin, concurrent administration of nonsteroidal anti-inflammatory drugs should be avoided.
5. Ongoing clinical trials will add clinically meaningful information regarding who will receive the greatest benefit with the least risk from aspirin.

Keywords: Aspirin, Anti-Inflammatory Agents, Non-Steroidal, Biological Availability, Cardiovascular Diseases, Diabetes Mellitus, Gastrointestinal Hemorrhage, Intracranial Hemorrhages, Metabolic Syndrome, Primary Prevention, Proton Pump Inhibitors, Risk Assessment, Risk Factors

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