Salt Lake City, UT -- (ReleaseWire) -- 08/20/2021 --Individuals with cardiovascular disease who are taking aspirin to lower their chances of suffering a heart attack or stroke experienced similar health benefits, including reduced death and hospitalization for heart attack and stroke, whether they took a high or low dose of aspirin, according to a new national multi-center study led by Duke University, that included researchers at the Intermountain Healthcare Heart Institute.
The study, which was recently presented at the American College of Cardiology's 70th Annual Scientific Session and published in the New England Journal of Medicine, is the first large-scale study of aspirin dosing to be embedded in real-world practice and the first randomized controlled trial to be conducted using the National Patient-Centered Clinical Research Network.
Heart disease – and atherosclerosis, in particular – which is a narrowing and hardening of the arteries is a leading cause of death for men, women, and most racial and ethnic groups in the United States, with estimated direct costs of $214 billion, according to the American Heart Association.
Millions of Americans with heart disease take recommended aspirin therapy to help reduce their risk of heart attack and stroke, a decades-long practice that has, until now, lacked definitive research studying the doses that work best for patients and minimize potentially serious side effects, such as major bleeding.
"We found that both doses had similar effectiveness and safety, and while there were differences in dose switching between the groups, generally patients with heart disease should take low-dose aspirin given its tolerability and no clear benefit with higher doses of daily aspirin," said Kirk Knowlton, MD, Intermountain Healthcare.
Researchers in the study, called ADAPTABLE, followed 15,076 people with cardiovascular disease who were identified via electronic health records and randomized to self-administer either 81 mg or 325 mg of daily aspirin for a median of 26.2 months.
Participants were enrolled at 40 medical centers across the nation and a health plan engaged in the PCORnet network. Most follow-up to obtain patient-reported information occurred via a patient portal, with the rest occurring via telephone calls.
While the researchers found no significant difference between the two doses in safety or effectiveness, they noted the higher dose group was much more likely to switch doses during the study. The patients in this group also were slightly more likely to discontinue the use of aspirin, for reasons including tolerability and participant and clinician preferences, among others.
Researchers say the ADAPTABLE study provides useful evidence to inform patients and clinicians who advise them on aspirin dosing decisions.
"Sometimes health care is based on years of routine practice and when rigorous studies are conducted, we can evolve that practice from common sense to evidence," noted Nakela L. Cook, MD, MPH, executive director of Patient-Centered Outcomes Research Institute. "That's why PCORI funds studies like ADAPTABLE that aim to enhance decision making with useful evidence."
About Intermountain Healthcare
Intermountain Healthcare is a not-for-profit system of 24 hospitals, including Primary Children's Hospital, 215 clinics, a Medical Group with 2,500 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Idaho, Utah, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs.