Over 4.37 years, a total of 154 atherosclerotic vascu- lar events occurred (68 in the aspirin group [13.6 per 1000 person-years] and 86 in the nonaspirin group [17.0 per 1000 single fatal stroke occurred in the aspirin group, but 5 strokes occurred in the nonaspirin group; thus, the study was insuf- ficiently powered to detect an effect on stroke. Severallargeprimarypreventiontrialshaveincludedsubgroup analyses of patients with diabetes mellitus. The Antithrombotic Trialists Collaboration meta-analysis of 287 randomized trials reported effects of antiplatelet therapy (mainly aspirin) versus There was 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 helps to shed new light on this controversial A total of 11618 participants were included in the anal- ysis. The 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). Because hyper- glycemia reduces platelet sensitivity to aspirin,324 an important consideration in patients with diabetes mellitus is aspirin dose. In another meta-analysis, there was no evidence that aspirin dose explained the lack of an aspirin effect on cardiovascular and stroke mortality in patients with diabetes mellitus.325 However, the systematic review identified an important gap in random- ized, controlled trials for using anywhere between 101 to 325 mg aspirin daily in patients with diabetes mellitus. Diabetes: Summary and Gaps A comprehensive program that includes tight control of hyper- tension with ACEI or ARB treatment reduces the risk of stroke in people with diabetes mellitus. Glycemic control reduces microvascular complications, but there remains no evidence that improved glycemic control reduces the risk of incident stroke. 