aspirin and heart disease

Answering an Age-Old Question about Aspirin for Heart Disease

Heart disease kills more people in the United States than any other health condition. In 2019, heart disease caused one in every four men’s deaths in the country, according to the Centers for Disease Control and Prevention. As a cardiologist, I have seen firsthand that while cardiovascular disease (all types of diseases that affect the heart or blood vessels) is often thought of as a man’s disease, women—our wives, mothers, sisters, and daughters—die from cardiovascular disease in almost equal numbers as men.


New Study Can Help Guide Treatment Decisions

Doctors often recommend aspirin to prevent heart attacks or strokes in their patients who have heart disease or are at risk. But aspirin can sometimes cause side effects such as internal bleeding or an allergic reaction. For decades, doctors haven’t known whether regular strength or baby aspirin is best to protect against a heart attack or stroke while minimizing risks. With the results of the ADAPTABLE study, funded by the Patient-Centered Outcomes Research Institute (PCORI) and led by investigators at Duke Clinical Research Institute, we now have information answering that question. This new evidence can help people with heart disease and their doctors determine which aspirin dose would be the safest, most effective long-term treatment for them.

The ADAPTABLE study researched whether low dose or regular strength aspirin is more effective at preventing heart attacks, strokes, or deaths and whether one is less likely to cause bleeding. The research team found overall there were no differences in rates of death, hospitalization for a heart attack or stroke, and bleeding between participants who took a baby aspirin dose of 81 mg and those who took a regular strength dose of 325 mg, though those who took the higher dose were more likely to switch doses. Researchers who led the study are planning to examine factors that led to either staying on the high dose or switching.


What Does This Mean for Me?

If you are on aspirin therapy now (or care for someone who is), you can use these study results as part of a conversation with your doctor to determine the right approach for you. Taking aspirin is still recommended for people with established heart disease. Also, remember that there are things you can do to reduce your risk of heart disease. The National Heart, Lung, and Blood Institute recommends reducing your sodium intake; increasing the number of fruits, vegetables, and whole grains in your diet; getting regular physical activity; maintaining a healthy weight; being a nonsmoker; and finding ways to manage stress.


What Kind of Study Was This?

This study was unique because it shifted the role of the patient from participant to partner. Adaptors, people on aspirin therapy who represented the patient community, were involved in the study from the beginning. One of our core beliefs at PCORI is that patients and their caregivers should be included in research as partners with invaluable lived experience and perspective to offer. In this study, the Adaptors gave researchers the patient perspective by asking questions, sharing experiences, and participating in working groups and scientific meetings.

ADAPTABLE was different than past studies because it looked at the real-world, everyday experiences of more than 15,000 people taking aspirin. Involving that many people made it more likely the group represented the full range of people across the country. It was different in another way, as well. Researchers conducted the study’s key activities—identifying and reaching out to potential participants, obtaining their consent, and following up them during and after the study—electronically, making things easier for the people taking part. PCORnet®, the National Patient-Centered Clinical Research Network, which PCORI funded, made this unique approach possible. This national resource enables more efficient patient-centered clinical research by tapping into real-world health data collected during routine care. We were pleased that ADAPTABLE was the first randomized trial to use PCORnet.

Heart disease can present a real challenge to patients and their families. PCORI has funded many studies and related projects to lessen that burden and help people make the best possible decisions as they endeavor to maintain a healthy heart.



Nakela Cook, MD, MPH

View posts by Nakela Cook, MD, MPH
Nakela L. Cook, MD, MPH, is Executive Director at the Patient-Centered Outcomes Research Institute (PCORI). She is a cardiologist and health services researcher with a distinguished career leading key scientific initiatives engaging patients, clinicians, and other healthcare stakeholders at one of the nation’s largest public health research funders. Throughout her career, Cook has worked to enhance diversity and equity in research and care delivery and been a leader in efforts to reduce disparities in health access and outcomes. She has received numerous awards for her excellence in clinical teaching and mentorship as well as her leadership of complex scientific initiatives and programs.

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