No interaction between race and aspirin dose for the secondary prevention of cardiovascular disease

1. In patients with an established history of atherosclerotic cardiovascular disease (ASCVD) randomized to either take a daily high (325mg) or low (81mg) dose aspirin, there was no interaction between race and the primary endpoint consisting of death, hospitalization for myocardial infarction, or stroke. 

Evidence Rating Level: 1 (Excellent) 

In the USA, there are disparities in the outcome of atherosclerotic cardiovascular disease (ASCVD) between Black and non-Black patients. This disparity is due to many factors, one of which may be the different reactions of platelets in self-reported Black patients to aspirin. Aspirin prevents clinical events in patients with ASCVD and is a recommended option for secondary prevention of cardiovascular events. However, no study has looked at the dose-dependent effect of aspirin on Black patients. The ADAPTABLE randomized controlled trial compared the effects of two different doses of aspirin (81mg or 325mg daily) on clinical outcomes of 15 076 patients in the USA. This study used ADAPTABLE to evaluate the dose-dependent effect of aspirin. The primary endpoint was a composite of death from any cause, hospitalization for myocardial infarction, or stroke. Secondary endpoints included coronary revascularization or coronary artery bypass graft. The primary safety endpoint was a hospitalization for bleeding requiring transfusion. Over the 26.2 months median follow-up, the primary effectiveness endpoint was significantly higher in Black and other participants relative to White participants (overall p value < 0.001). The dosage of aspirin did not affect primary effectiveness endpoint (p = 0.12), primary safety endpoint (p = 0.46), or secondary effectiveness endpoint. 

Click to read the study in PLOS ONE

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