Diabetes is a major global public health problem—by 2025 an estimated 300 million people worldwide will be affected.1 With the associated twofold to fourfold increased risk of cardiovascular disease, more than half of these people will die prematurely from vascular events.2 Treatments that lower lipids, blood pressure, and glucose all reduce the risk of cardiovascular disease safely (preventing first and subsequent events), but even with effective treatment patients with diabetes are at high risk.3 4 5 Further treatments are therefore needed to reduce this risk. In the linked meta-analysis (doi:10.1136/bmj.b4531), De Berardis and colleagues assess the benefits and harms of low dose aspirin in people with diabetes and no cardiovascular disease.6

Because most people with diabetes live in low and middle income countries, such treatments should ideally be inexpensive as well as safe and effective. Aspirin is cheap, widely available, and recommended (and taken) to reduce the risk of recurrent events for people (including those with diabetes) who have survived a vascular event or …