The POPADAD (Prevention Of Progression of Arterial Disease And Diabetes) study did not show a benefit for low-dose aspirin therapy or administration of antioxidants for the primary prevention of cardiovascular disease events in individuals with diabetes and asymptomatic peripheral arterial disease. Although low-dose aspirin continues to be recommended in international guidelines, no convincing trial-based evidence exists that supports its routine use for primary prevention of cardiovascular disease in people with diabetes. This paradox is unhelpful and the guidelines should be relaxed until definitive evidence becomes available.