136. ACC 2021 Prevention Highlights ADAPTABLE and STRENGTH Trials
Join\xa0CardioNerds\xa0for a great discussion about key ACC 2021 Prevention highlights featuring the ADAPTABLE and STRENGTH trials. This episode is produced in collaboration with the American College of Cardiology Prevention of Cardiovascular Disease Council with mentorship from the Council\u2019s Chair Dr. Eugene Yang (University of Washington Medical Center) who provides a message at the end of the episode.\xa0\xa0\n\n\n\nFirst, Dr. Amit Goyal and Council Representative Dr. Mahmoud Al Rifai (FIT, Baylor College of Medicine) discuss the\xa0implications\xa0of the ADAPTABLE Trial with Dr. Gina Lundberg (Emory University School of Medicine).\xa0\xa0\n\n\n\nThen Dr. Tommy Das (FIT, Cleveland Clinic), Dr. Rick Ferraro (FIT, Johns Hopkins) and Council Representative Dr. Anum Saeed (FIT, University of Pittsburgh Medical Center) discuss the results of the STRENGTH trial\u2019s secondary analysis with Dr. Steven Nissen (Cleveland Clinic).\xa0\xa0\n\n\n\nDisclosures: Dr Nissen reported grants from AstraZeneca during the conduct of the STRENGTH trial\n\n\n\n\n\n\n\n\n\nCardionerds Cardiovascular Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll\n\n\n\n\n\nSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!\n\n\n\n\n\n\n\n\n\nShow notes \n\n\n\nADAPTABLE Trial\xa0\n\n\n\nThe ADAPTABLE trial is a randomized open label pragmatic trial comparing two doses of aspirin (325 mg vs. 81 mg) for the secondary prevention of cardiovascular disease. The trial employed a range of innovative and low-cost methods to simplify the identification, recruitment, and follow-up of patients. The primary effectiveness outcome was a composite of death from any cause, hospitalization for myocardial infarction, or hospitalization for stroke. The primary safety outcome was hospitalization for major bleeding.\xa0\n\n\n\nA total of 15,076 patients were followed for a median of 26.2 months. The primary effectiveness and safety outcomes were not significantly different between the two groups. Together with Dr. Lundberg we discuss design and methodological issues related to the trial and applicability to clinical practice.\xa0\xa0\n\n\n\nASA 81 mg is as effective as ASA 325 mg for reducing cardiovascular events\xa0ASA 325 mg does not cause more bleeding episodes than ASA 81 mg\xa0ASA dosing should be based on a clinician-patient risk discussion incorporating patients\u2019 risk profile and their values and preferences\xa0\xa0Future trials should ensure adequate representation of women and race/ethnic minorities\xa0\xa0\n\n\n\nThe results of the present trial suggest that either dose of ASA (81 mg or 325 mg) would be adequate to lower patients\u2019 risk of death or atherosclerotic cardiovascular events with similar risk of bleeding. ASA dosing should be based on patient values and preferences and clinician judgement as the effectiveness and safety profile of these two regiments appears to be equivalent on the basis of the present trial.\xa0\xa0\n\n\n\nSTRENGTH Trial, Secondary Analysis\xa0\n\n\n\nWhether omega-3 fatty acids\xa0eicosapentaenoic\xa0acid (EPA) and docosahexaenoic acid (DHA) reduce cardiovascular risk has been long debated. Data have largely remained inconclusive with several previous trials, particularly the VITAL and ASCEND, showing\xa0no significant cardiovascular benefit DHA and EPA supplementation. However, the REDUCE-IT and the JELIS trials showed cardiovascular benefit with higher dose of purified EPA compared to placebo.\xa0 Meanwhile, the STRENGTH trial did not show any difference in CVD outcomes in treatment groups using a combined EPA/DHA formulation.\xa0\n\n\n\nIn this episode, we discuss a secondary\xa0anaylsis\xa0from the STRENGTH trial entitled\xa0\u201cAssociation Between Achieved \u03c9-3 Fatty Acid Levels and Major Adverse Cardiovascular Outcomes in Patients With High Cardiovascular Risk\u201d presented at the ACC 2021\xa0addressing the effects of carboxylic acid formulation of EPA/DHA (omega-3 CA) compared with placebo among patients with dyslipidemia and high cardiovascular risk.\xa0\xa0\n\n\n\nThis analysis showed that there was no added clinical benefit or harm i...