Comparative Effectiveness of Aspirin Dosing in DM and ASCVD Patients: ADAPTABLE Trial

What is it about?

In the ADAPTABLE study, patients with diabetes mellitus (DM) and chronic, stable atherosclerotic cardiovascular disease (ASCVD) were randomized to receive either 81 mg or 325 mg of daily aspirin. The effects of aspirin dosing were assessed on primary effectiveness and safety outcomes. The results showed that patients with DM had higher rates of the composite cardiovascular outcome and bleeding events compared to those without DM. However, there was no difference in the primary effectiveness outcome or safety outcome between the two aspirin dosing groups in patients with or without DM. The study suggests that a higher dose of aspirin yields no added clinical benefit, even in a more vulnerable population.

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Why is it important?

The research is important as it provides insights into the effectiveness and safety of aspirin dosing in patients with diabetes mellitus (DM) and concomitant atherosclerotic cardiovascular disease (ASCVD). It helps to determine whether a higher dose of aspirin offers any additional clinical benefit for patients with DM, who are already at a higher risk due to their condition. The study is significant because it is based on a large open-label, pragmatic, multicenter trial involving 15,076 patients with established ASCVD, of whom 5,676 had a documented history of DM. Key Takeaways: 1. Patients with DM had a higher burden of cardiovascular comorbidities, such as hypertension, hyperlipidemia, chronic kidney disease, chronic obstructive pulmonary disease, peripheral artery disease (PAD), prior PCI or CABG surgery, and prior MI compared with patients without DM. 2. Patients with DM had a higher likelihood of prior bleeding, baseline P2Y12 inhibitor use, peptic ulcer disease, and significant GI bleeding compared with patients without DM. 3. After adjustment for baseline characteristics, patients with DM had no difference in the primary composite effectiveness outcome of death, MI, or stroke or safety outcomes when comparing the 81-mg vs. 325-mg daily dosing strategies of aspirin. 4. The research suggests that there is no differential effect in low or high daily dosing in patients with DM and established ASCVD, and that a higher dose of aspirin does not offer any added clinical benefit for this vulnerable population.