One of the main purposes of treating diabetes is to prevent or reduce the occurrence of chronic complications of diabetes, especially the occurrence of cardiovascular and cerebrovascular lesions. Aspirin is very effective in the prevention and treatment of cardiovascular and cerebrovascular diseases, and many diabetic patients ask me at work whether they need to take aspirin, and today we will talk about the problems related to the use of aspirin in diabetic patients. The American Diabetes Association (ADA), the American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF) recently issued a statement that pushed back the age of primary prevention of cardiovascular events with aspirin for diabetic patients at risk for cardiovascular disease to over 50 years for men and over 60 years for women. Primary prevention is a strategy to prevent disease by taking preventive measures to control and reduce cardiovascular risk factors, prevent cardiovascular events, and reduce morbidity in a population when the disease has not yet occurred or when the disease is in a subclinical stage.” The statement “provides some specific recommendations and guidance for the treatment of patients with diabetes. China has more than 92 million diabetic patients, of which about 80% eventually die from cardiovascular complications, reducing the cardiovascular risk of diabetic patients has become a common concern of both doctors and patients and the whole society. For the primary prevention of cardiovascular disease, aspirin has been proven to reduce the occurrence of cardiovascular events in high-risk groups, including diabetic patients. However, it is currently believed that aspirin may not reduce the risk of cardiovascular disease in diabetic patients over 40 years of age without cardiovascular disease or in diabetic patients without a history of atherosclerosis. The risk of adverse cardiovascular events needs to be carefully evaluated when determining whether to apply aspirin to patients with diabetes, weighing its cardiovascular benefit against the risk of bleeding complications. The higher the patient’s risk of cardiovascular events, the greater the magnitude of the benefit of primary prevention with aspirin. Based on the overall cardiovascular risk, aspirin use for primary prevention in patients with diabetes can be categorized into three risk classes: high, moderate, and low, i.e., cardiovascular risk greater than 10% over 10 years, as well as cardiovascular risk between 5% and 10% over 10 years, and cardiovascular risk less than 5% over 10 years. The use of overall cardiovascular risk for the assessment of cardiovascular complications in diabetes, rigorous screening of high-risk groups for cardiovascular disease, adequate assessment of the benefit-to-risk ratio, and recommendation of aspirin use based on the overall cardiovascular risk assessment are key to the efficacy of primary prevention. In the high-risk group, a clear recommendation is given because of the positive efficacy. Those with increased cardiovascular risk include most men over 50 years of age or women over 60 years of age with diabetes and at least 1 other risk factor (smoking, hypertension, dyslipidemia, family history of early-onset coronary heart disease, proteinuria). For those at moderate risk: weigh the benefit against the risk and consider it. Patients with diabetes at moderate cardiovascular risk include men under 50 years of age or women under 60 years of age with one or more risk factors, or men over 50 years of age or women over 60 years of age without other risk factors, with a 10-year cardiovascular risk of 5% to 10%) are recommended to apply low-dose aspirin (75-162 mg/day) for the prevention of cardiovascular events. For low-risk groups: it is not currently applied as a routine. By low cardiovascular risk level, we mean diabetic patients under 50 years of age in men or under 60 years of age in women with no other major risk factors and a 10-year cardiovascular risk of less than 5% are not recommended for routine application of aspirin for the prevention of cardiovascular events; the potential risk of bleeding complications with aspirin application in such patients may outweigh their cardiovascular benefit. However, it is undeniable that aspirin can lead to an increased risk of bleeding in addition to preventing the formation of blood clots. Therefore, it is important to balance the benefits and risks of aspirin. The majority of diabetic patients encountered in clinical work are in need of aspirin. If you are a diabetic patient, you will need to discuss your risk factor stratification with your physician at the time of your visit to determine if you should apply aspirin for primary prevention of cardiovascular events.