Patients with diabetes mellitus and stable coronary disease are at higher risk of cardiovascular events, like stroke or myocardial infarction. Ticagrelor-aspirin combination is known to reduce the risk of cardiovascular disease, but the exact effects of ticagrelor are unclear. The objective of this study is to evaluate the efficacy of ticagrelor in patients with diabetes and stable coronary disease. 

This is a randomized, double-blind trial conducted on a total of 19,229 patients aged 50 years and older who had type-2 diabetes mellitus and stable coronary artery disease. The participants were randomly assigned to ticagrelor plus aspirin or placebo plus aspirin. The primary outcome was the incidence of cardiovascular events, including stroke, myocardial infarction, or death.

At the median follow-up of 39.9 months, permanent treatment discontinuation was more common in the ticagrelor group (34.5%) than in the placebo group (25.4%). The incidence of ischemic cardiovascular events was less common in the ticagrelor group (7.7%) than in the placebo group (8.5%). However, the risk of major bleeding and intracranial hemorrhage was more common in the ticagrelor group. There was no significant difference in the incidence of fatal bleeding. 

The research concluded that in patients with type-2 diabetes and stable coronary disease, the ticagrelor-aspirin combination could lower the incidence of ischemic cardiovascular events, but increase the risk of major bleeding than placebo-aspirin.

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Ref: https://www.nejm.org/doi/full/10.1056/NEJMoa1908077