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Risk and Benefits of Aspirin in Primary Prevention in Both Men and Women Better Defined

Henry I. Bussey, Pharm.D., FCCP, FAHA
January, 2006

Review: Jeffrey S. Berger, MD, MS; Maria C. Roncaglioni, MD; Fausto Avanzini, MD; Ierta Pangrazzi, MD; Gianni Tognoni, MD; David L. Brown, MD. Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men: A Sex-Specific Meta-analysis of Randomized Controlled Trials. JAMA. 2006;295:306-313.

New meta-analysis of aspirin in primary prevention that included more than 51,000 women and more than 44,000 men finds that such therapy reduces cardiovascular events and MI (but not stroke) in men and reduces cardiovascular events and stroke (but not MI) in women. Aspirin use was associated with an increased major bleeding rate that roughly equaled the risk reduction in thromboembolic endpoints. The authors point out that gender difference (more apparent MI protection in men and more stroke protection in women) may be a statistical issue because the men have a higher MI rate and the women have a higher stroke rate. Further, whether a larger dose of aspirin may carry and increased risk of bleeding and/or a reduced level of thromboembolic protection was examined by comparing the one study that used a larger than recommended dose of aspirin (the British Doctors’ Trial which used 500 mg daily) with the other trials. The larger dose aspirin trial did not appear to have a higher bleeding risk but it did appear to have a lower protective effect on cardiovascular events and MI. Of course, findings derived by comparing results across studies must be viewed with caution. It would appear that the decision to use aspirin for primary prevention must include consideration of the individual patient’s risk of a thromboembolic event (MI or stroke) with higher risk patients receiving proportionally more benefit from aspirin. Similarly, the increased risk of major bleeding with even low dose aspirin may be roughly equivalent to - or even exceed - the protective effects of aspirin in many patients.

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