{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T13:40:29Z","timestamp":1790862029130,"version":"4.1.0"},"reference-count":47,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2018,8,1]],"date-time":"2018-08-01T00:00:00Z","timestamp":1533081600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Eur J Clin Investigation"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Patients with diabetes are at high cardiovascular (<jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content>) risk due to an exaggerated platelet activation and aggregation. In the first 2000s low\u2010dose aspirin was first recommended for primary prevention, but then re\u2010discussed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This short narrative review, based on the material searched for and obtained via PubMed up to February 2018, aims at clarifying this controversial topic.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The <jats:styled-content style=\"fixed-case\">JPAD<\/jats:styled-content>2 study has been designed to evaluate the occurrence of any <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> event in a cohort of patients with diabetes and concluded that low\u2010dose aspirin did not influence the risk for <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> events while increasing the risk for gastrointestinal (<jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content>) bleeding. Reasons for this result can be found in the role of diabetic platelets, which are known to be hyperreactive, thus producing intensified adhesion, activation, and aggregation. In this setting, other associated metabolic conditions can concur to enhance platelet adhesion and activation. Aspirin resistance has been often considered a guilty actor, although many mechanisms have been mistaken for true aspirin resistance, such as patient poor compliance, inadequate dosing, drug interactions, and high\u2010platelet turnover. However, the mere presence of diabetes is not likely to give a net benefit for <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> protection with respect to <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> bleeding.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It appears advisable to follow current guidelines addressing first of all classical risk factors and evaluate aspirin therapy in primary prevention only for patients with type 1 or 2 diabetes at increased <jats:styled-content style=\"fixed-case\">CV<\/jats:styled-content> risk and no risk for <jats:styled-content style=\"fixed-case\">GI<\/jats:styled-content> bleeding. Anyway, additional clinical trials are needed to address the current topic.<\/jats:p><\/jats:sec>","DOI":"10.1111\/eci.13001","type":"journal-article","created":{"date-parts":[[2018,7,16]],"date-time":"2018-07-16T12:45:53Z","timestamp":1531745153000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Aspirin in primary prevention for patients with diabetes: Still a matter of debate"],"prefix":"10.1111","volume":"48","author":[{"given":"Aldo","family":"Bonaventura","sequence":"first","affiliation":[{"name":"First Clinic of Internal Medicine Department of Internal Medicine University of Genoa Genoa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Liberale","sequence":"additional","affiliation":[{"name":"Center for Molecular Cardiology University of Zurich Zurich 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