What evidence is there to suggest that aspirin is effective in reducing stroke risk in patients with diabetes mellitus?
Several large primary prevention trials have included subgroup analyses of patients with diabetes mellitus. The Antithrombotic Trialists Collaboration meta-analysis of 287 randomized trials reported a nonsignificant 7% reduction in serious vascular events, including stroke, in the subgroup of 5126 patients with diabetes mellitus. A meta-analysis covering the interval between 1950 and 2011 included 7 studies in patients with diabetes mellitus without previous CVD and found an overall relative risk for major cardiovascular events was 0.91 (95% CI, 0.82 1.00), but an effect on stroke incidence was not found (RR, 0.84; 95% CI, 0.64 1.11). However, there was no evidence that aspirin dose explained the lack of an aspirin effect on cardiovascular and stroke mortality in patients with diabetes mellitus.