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Aspirin

 

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Image Courtesy Esra Su; Source: commons.wikimedia.org

  1. When used for secondary prevention of cardiovascular disease, aspirin was shown to be beneficial in women.

  2. ASA is not as well studied in primary prevention in women patients but may provide some benefits in women with at least one risk factor .  In addition, the Women’s Health Study aslo found that in average risk women, low dose aspirin lowered the risk of stroke without affecting the risk of MI or death.[4]

  3. ASA in diabetics and other high risk individuals should be strongly considered (consensus. Quality of evidence II, Grade B recommendation).[1][10]

The American Heart Association published recommendations in 2002 stating that aspirin should be used as primary prevention for coronary events in persons with a 10-year risk of an incident myocardial infarction that is greater than 10 percent [5]. Recently, the press coverage of the study by Ridker et al. indicated aspirin does not prevent heart attacks in women. In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction [4]. The very-low-dose- aspirin (100 mg every other day) is not effective in preventing MI in women but can decrease the risk of stroke by 25 percent. Higher dose of aspirin (100 mg per day) according to the "Primary Prevention Trial" was effective in preventing MI in women and in men [7]. However in the Hypertension Optimal Treatment trial, 75 mg of aspirin per day was effective as prevention in men but ineffective in women [6]. The minimum dose of aspirin needed for a cardioprotective effect is higher in women than in men and is greater than 75 mg per day. Aspirin significantly increases the risk of bleeding to a similar degree among women and men.[8]

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1. Amberson, B.L., (2000) Risk Factors and Primary Prevention of Ischemic Heart Disease in Women. Canadian Cardiovascular Society Consensus Conference: Women and Ischemic Heart Disease, October 2000: 4/1-4/25.

4. Ridker PM, Cook NR, Lee I-M, et al. A Randomized trial of Low-Dose Aspirin in the Primary Prevention of Cardiovascular Disease in Women. NEJM 2005;352:1293-1304.

5. Pearson TA, et al. AHA Guidelines for Primary Prevention of Cardiovascular Disease and Stroke: 2002 Update: Consensus Panel Guide to Comprehensive Risk Reduction for Adult Patients Without Coronary or Other Atherosclerotic Vascular Diseases. American Heart Association Science Advisory and Coordinating Committee. Circulation 2002;106:388-91

6. Hansson L, et al. Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group.Lancet 1998;351:1755-62

7. de Gaetano G, Collaborative Group of the Primary Prevention Project. Low-dose aspirin and vitamin E in people at cardiovascular risk: a randomised trial in general practice. Collaborative Group of the Primary Prevention Project.Lancet 2001;357:1134

8. Aspirin for the Primary Prevention of Cardiovascular in Women and Men. A Sex-Specific Meta-analysis of Randomized Controlled Trials JAMA 2006;295:306-313

10. Mosca L, et al. Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women. AHA/ACC 2004 Scientific Statement. Circulation 2004;109:672-693.

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