The lack of increased bleeding risk with aspirin in those with diabetes mellitus was also found in the observational study cited above (incidence rate ratio for aspirin Diabetes mellitus was independently associated with an increased risk of major bleeding regardless of aspirin use (RR, 1.36; 95% CI, 1.28 1.44). A meta-analysis of 7 trials (11618 subjects) of the effects of aspirin in patients with diabetes mellitus found a treat- ment-associated 9% reduction in major cardiovascular events (RR, 0.91; 95% CI, 0.82 1.00) but found no significant reduc- tion in stroke (RR, 0.84; 95% CI, 0.64 1.11).323 Four additional meta-analyses also found no reduction in stroke with aspirin in subjects with diabetes mellitus.884 887 A focused, multisociety position paper on the primary prevention of cardiovascular events in people with diabetes mellitus considered these and other studies and recommended low-dose aspirin for adults with diabetes mellitus who have a 10-year cardiovascular risk >10% (men >50 years of age and women >60 years of age who have at least 1 additional major risk factor such as smoking, hypertension, dyslipid- emia, a family history of premature CVD, or albuminuria) and who are not at high risk of aspirin-related bleeding complica- It was further recommended that aspirin not be used for cardiovascular prevention among those with diabetes mel- litus at low risk and that aspirin might be considered for those at intermediate (10-year risk in the 5% 10% range) risk. Relatively few women were enrolled in the primary preven- tion trials that showed a benefit of aspirin in the prevention of coronary heart events but no reduction in stroke. 