No sex-specific differences are noted in the effectiveness and safety of two doses of aspirin for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events, a secondary analysis of the ADAPTABLE trial shows. These data were reported by Catherine P. Benziger, MD, of the Essentia Health Heart and Vascular Center, Duluth, Minnesota, and colleagues, in a manuscript published online in JAMA Cardiology. The leading cause of morbidity and mortality in the U.S. continues to be ASCVD. Aspirin is often recommended for prevention of ASCVD, and the ADAPTABLE (Aspirin Dosing: A Patient-Centric Trial Assessing Benefits and Long-Term Effectiveness) trial showed no safety nor efficacy differences in daily aspirin dosing at 81 mg or 325 mg. The investigators in this study examined potential sex-specific differences in the safety and effectiveness of two aspirin doses in the ADAPTABLE trial. ADAPTABLE was an open-label, pragmatic, multicenter, randomized clinical trial that gave patients with chronic, stable ASCVD either 81 mg or 325 mg of aspirin daily. Primary effectiveness outcomes in the ADAPTABLE trial were all-cause death and hospitalization for myocardial infarction (MI) or stroke. Hospitalization for major bleeding that required transfusion was the primary safety outcome. Over a median of 26.2 months, a total of 15,076 patients (median age=67.6 years, 31.3% female). Of the female patients, 2,307 of them received the 81 mg dose of aspirin. Female participants were also younger, compared with males (median age=66.3 years versus 68.2 years). Female participants were less likely to self-report white race (72.5% versus 82.7%), more likely to be a smoker (12.9% versus 8.4%) and had more instances of a history of peripheral artery disease. A total of 379 female and 780 male participants had an observed primary outcome occurrence. No significant interaction was observed by sex for the primary effectiveness endpoint between the two aspirin doses (female: adjusted hazard ratio [aHR]=1.01, 95% confidence interval [CI]=0.82-1.26; male: aHR=1.06, 95% CI=0.91-1.23; pinteraction=0.74). Female patients had fewer revascularization procedures during the trial (n=237) compared with males (n=680). However, females had a higher risk of hospitalization for stroke (aHR=1.72, 95% CI=1.27-2.33, p<0.001). In female patients, bleeding rates were slightly higher in the group that took 81 mg of aspirin, compared with the 325 mg cohort (20 versus 13, aHR=2.21, 95% CI=1.04-4.70, pinteraction=0.07). No significant differences were observed between female and male participants in adherence to dosage of aspirin. Overall, no significant sex-specific differences were noted in the safety and efficacy of 2 aspirin doses for the secondary prevention of ASCVD-related events. Source: Benziger CP, Stebbins A, Wruck LM, et al. Aspiring Dosing for Secondary Prevention of Atherosclerotic Cardiovascular Disease in Male and Female Patients: A Secondary Analysis of the ADAPTABLE Randomized Clinical Trial. JAMA Cardiol. 2025 Jan 2 (Article in Press). Image Credit: Grzegorz – stock.adobe.com