Research · PMID 30146931 · Landmark study
Reviewed by Neal Rouzier, MD, Preventive Medicine · Sep 2026
Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus.
The New England journal of medicine · October 2018 · ASCEND Study Collaborative Group, Louise Bowman, Marion Mafham, Karl Wallendszus, Will Stevens, et al.
What this study found
Aspirin use prevented serious vascular events in persons who had diabetes and no evident cardiovascular disease at trial entry, but it also caused major bleeding events. The absolute benefits were largely counterbalanced by the bleeding hazard.
Why this trial matters
ASCEND aspirin diabetes
How RAGMD uses this study
Clinical questions this paper informs
Synthesis lives on the evidence question — this page shows where the study sits in that analysis.
Primary study
Should aspirin be used for primary cardiovascular prevention?
Current guidelines generally discourage routine aspirin for primary prevention in low-to-moderate-risk adults because bleeding harm offsets modest benefit. Select high-risk individuals may still be considered with shared decision-making.
Open evidence analysisSupporting literature
Does hormone therapy improve metabolic syndrome markers?
Menopausal hormone therapy may favorably affect some metabolic markers in selected women but is not a primary treatment for metabolic syndrome. Lifestyle and cardiometabolic risk management remain foundational.
Open evidence analysisSupporting literature
Can hormone therapy help insulin resistance in peri- and postmenopausal women?
Some studies show improved insulin sensitivity with estrogen-based therapy in early postmenopause, but results are not uniform across regimens. HRT should not replace evidence-based diabetes prevention or treatment.
Open evidence analysisSupporting literature
Does testosterone therapy affect blood pressure?
Testosterone effects on blood pressure are modest and inconsistent across trials. Monitoring blood pressure remains part of routine TRT follow-up, especially with fluid retention or erythrocytosis.
Open evidence analysisSupporting literature
Do omega-3 supplements prevent cardiovascular disease in the general population?
High-dose EPA (icosapent ethyl) reduced events in selected high-risk statin-treated patients in REDUCE-IT. General over-the-counter omega-3 supplements show inconsistent or null benefit in primary prevention populations.
Open evidence analysis