Aspirin Resistance and Diabetes: A 2019 Study’s Surprising Findings

aspirin resistance and diabetes

Aspirin Resistance and Diabetes: A 2019 Study’s Surprising Findings

Last Updated: July 31, 2025

It’s a cornerstone of modern medical wisdom: patients with chronic conditions like diabetes, high blood pressure, and obesity are at a much higher risk for cardiovascular events. It’s also widely believed that these same conditions can create a state of “hyper-reactive” platelets, potentially making standard antiplatelet therapy like aspirin less effective. This has led many to assume a strong link between aspirin resistance and diabetes or other major comorbidities.

However, science often challenges our assumptions. A comprehensive 2019 doctoral thesis from Pakistan did just that. After analyzing 384 heart disease patients, the research produced a series of surprising “null results,” finding no statistically significant link between aspirin failure and several of the most common chronic health conditions. This post explores these unexpected findings and what they tell us about the complex nature of aspirin efficacy.

The Study: A Search for Risk Factors in High-Risk Patients

The research, conducted by Dr. Mudassar Noor at the National University of Medical Sciences, sought to identify factors that contribute to aspirin resistance in a real-world cohort of ischemic heart disease patients. Using Light Transmission Aggregometry (LTA)—the gold standard for measuring platelet function—the study meticulously categorized patients as either “aspirin responders” or “aspirin resistant.”

The researchers then cross-referenced this data with the patients’ major comorbidities, including diabetes mellitus, hypertension, body mass index (obesity), and cardiac failure, expecting to find clear correlations. What they found instead was a powerful lesson in clinical complexity.

Diabetes is a major risk factor for cardiovascular disease, partly because it’s associated with increased platelet activation and a pro-thrombotic state. The logical assumption is that this would lead to a higher rate of aspirin resistance among diabetic patients. However, the data from this study did not support that conclusion.

From the thesis results:

“The incidence of diabetes in our study population was 29.7% (n=114), the rest of 270 (70.3%) were non diabetics. One hundred and three (90.4%) diabetic and 228 (84.4%) non diabetic patients were responding to aspirin while 11 (9.6%) diabetic and 42 (15.6%) non diabetic patients were resistant to aspirin… The p value =0.125 suggests that diabetes has no correlation with aspirin resistance in our study.“

A Breakdown of the Numbers:

  • Aspirin Resistance in Diabetics: 9.6%
  • Aspirin Resistance in Non-Diabetics: 15.6%

Counter-intuitively, the prevalence of aspirin resistance was actually lower in the diabetic group in this cohort. While this doesn’t mean diabetes is protective, the lack of a positive correlation is a significant finding. A p-value of 0.125 is well above the 0.05 threshold for statistical significance, meaning there was no discernible link between having aspirin resistance and diabetes in this population. This contradicts several other studies and highlights the need for population-specific research.

Hypertension’s Role: Another Unexpected Null Result

Hypertension, or high blood pressure, is another major cardiovascular risk factor known to affect platelet function. The study investigated whether hypertensive patients were more likely to be aspirin resistant.

From the thesis text:

“In the current study there were 174 (45.3%) hypertensive and 210 (54.7%) were normotensive patients… There was no noteworthy statistical difference between the two groups p= 0.375.“

A Breakdown of the Numbers:

  • Aspirin Resistance in Hypertensive Patients: 15.5%
  • Aspirin Resistance in Normotensive Patients: 12.4%

Although the rate was slightly higher in the hypertensive group, the difference was not statistically significant. The study concluded that, in this cohort, high blood pressure did not meaningfully influence the antiplatelet effects of aspirin. This contrasts with other research that has found a positive connection, again underscoring that the factors driving aspirin resistance can be highly variable.

What About Obesity and Body Mass Index (BMI)?

Obesity is recognized as a pro-inflammatory and pro-thrombotic state, making it a prime suspect in causing aspirin resistance. The study categorized patients into normal weight, overweight, and obese groups based on Asian BMI standards to test this hypothesis.

From the thesis results:

“There was no significant statistical difference appreciated between aspirin responders and aspirin resistant cases in different BMI groups, p= .210… as measured by chi square test…”

A Breakdown of the Numbers:

  • Normal Weight (BMI 18.5-22.9): 9.6% were resistant.
  • Overweight (BMI 23-24.9): 14.0% were resistant.
  • Obese (BMI ≥ 25): 21.6% were resistant.

Here, a clear trend is visible: as BMI increased, so did the rate of aspirin resistance. However, despite this trend, the differences did not reach the threshold for statistical significance. This means that while a relationship might exist, it was not strong enough in this study to be declared a definitive link. It suggests that while obesity may contribute, it was not a primary driver of resistance in this population compared to other factors like smoking or dyslipidemia.

Conclusion: A Complex Picture Demands a Nuanced View

The findings from this 2019 Pakistani study are a powerful reminder that human biology is rarely simple. While it seems logical that major health conditions like diabetes, hypertension, and obesity would impair aspirin’s effectiveness, this well-conducted research found no statistically significant proof of that.

This doesn’t mean these conditions are benign. They remain profound risk factors for cardiovascular disease on their own. However, this study suggests they may not be the primary drivers of aspirin failure, at least not in this population. Instead, the research found much stronger links with factors like smoking and high cholesterol. This highlights the importance of looking at a patient’s entire profile and reinforces the need for more diverse, population-specific studies before we can truly predict who will and will not respond to aspirin therapy.

Author Bio: This analysis is based on the doctoral research of Dr. Mudassar Noor, conducted at the Department of Pharmacology & Therapeutics, Army Medical College, a constituent college of the National University of Medical Sciences (NUMS) in Rawalpindi, Pakistan.

Source & Citations

Disclaimer: Some sentences have been lightly edited for SEO and readability. For the full, original research, please refer to the complete thesis PDF.

Do these findings challenge what you thought you knew about aspirin’s effectiveness in patients with other health conditions? Share your perspective in the comments below!

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