How ADAPTABLE Study fits in the recent guidelines on use of aspirin in cardiovascular diseases

On March 17, 2019, the American College of Cardiology and the American Heart Association jointly published recommendations based on recent studies on the use of aspirin to prevent cardiovascular diseases. These studies involved participants who do not have heart disease or have not experienced a heart attack or stroke.

These recommendations, recently publicized in the media, show that aspirin is not effective for the majority of individuals who do not have a history of heart disease/heart attack or stroke. Doctors call this “primary prevention” because they are using aspirin to prevent the start of heart disease or the occurrence of a heart attack or stroke.

However, for ADAPTABLE participants and other individuals who are living with heart disease or have experienced a heart attack or a stroke, research still shows that aspirin is critically important. Doctors call this “secondary prevention” because they are using aspirin to prevent a future heart attack or stroke.

Current recommendations on use of aspirin

For individuals who have heart disease or had a heart attack or a stroke:

  1. Aspirin should be used most of the times.
  2. Aspirin is effective in reducing future heart heart problems.
  3. We still don’t know the best dose of aspirin (81 mg or 325 mg per day).
  4. The ADAPTABLE Study hopes to find the best dose of aspirin for patients who have a history of heart disease/heart attack or a stroke.

For individuals who do not have a history of heart disease or have not experienced a heart attack or a stroke:

  1. Aspirin should be used infrequently.
  2. Aspirin should be avoided in people more than 70 years old or who are at increased risk of bleeding.
  3. For people between 40 and 70 years old who are at increased risk of developing cardiovascular diseases in the future, aspirin at a dose of 75 to 100 mg per day can be considered, but the benefits are uncertain. People who have diabetes, high blood pressure, abnormal cholesterol, and/or a strong family history of cardiovascular disease should make a shared decision with their doctor to use or not to use aspirin.

How ADAPTABLE fits into the current recommendations

There is a lot of discussion around the usefulness of aspirin for the prevention of cardiovascular disease, yet it remains clear that aspirin is a mainstay of therapy for patients with established cardiovascular disease. ADAPTABLE is very well positioned to answer the clinical question about which dosage of aspirin is best for patients with disease.

Results from the ADAPTABLE study will inform future treatment decisions on what is the best dose of aspirin for individuals living with heart disease and to clarify practice recommendations regarding aspirin dose.

Read more at www.theaspirinstudy.org/news

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