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Aspirin Effective in Women for Stroke, Men for Heart
Attack
Review of trials with 95,456 participants finds
different results by sex
Jan. 18, 2006 Aspirin significantly reduces the
risk of cardiovascular problems in both women and men, but in women it
reduces the risk of stroke, and in men in lowers the risk of a heart
attack, says an analysis of previous studies in today's issue of JAMA.
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Although the benefits of aspirin therapy for
reducing the risk of heart attack (myocardial infarction MI), stroke,
and vascular death among men and women with preexisting cardiovascular
disease are well established, the role of aspirin in primary prevention
is less clear, according to background information in the article. And
it has not been clear if there is a differential beneficial effect
between men and women.
Jeffrey S. Berger, M.D., M.S., of Duke University,
Durham, N.C., and colleagues performed a sex-specific meta-analysis of
aspirin therapy for the primary prevention of cardiovascular events to
better understand the association of sex with the response to aspirin.
The researchers performed a search of databases to
identify randomized controlled trials of aspirin therapy in participants
without cardiovascular disease that reported data on heart attack,
stroke, and cardiovascular death.
Six trials with a total of 95,456 individuals were
identified; three trials included only men, one included only women, and
two included both sexes. The authors examined a combined endpoint of any
major cardiovascular event (cardiovascular death, nonfatal heart attack,
or nonfatal stroke), and each of these individual components separately.
Women
The researchers found that among the 51,342 women,
there were 625 strokes, 469 heart attacks, and 364 cardiovascular
deaths. Aspirin therapy was associated with a significant 12 percent
reduction in cardiovascular events and a 17 percent reduction in stroke,
which was a reflection of a 24 percent reduced rate of ischemic stroke.
There was no significant effect on heart attacks or cardiovascular
death.
Men
Among the 44,114 men, there were 597 strokes, 1,023
heart attacks, and 776 cardiovascular deaths. Aspirin therapy was
associated with a significant 14 percent reduction in cardiovascular
events and a 32 percent reduction in heart attacks. There was no
significant effect on stroke or cardiovascular death. Aspirin treatment
resulted in an approximately 70 percent increase in the risk of major
bleeding events among women and men.
The authors add that aspirin therapy for an average
of 6.4 years results in an average absolute benefit of approximately 3
cardiovascular events prevented per 1,000 women and 4 cardiovascular
events prevented per 1,000 men.
"...the favorable effect of aspirin on the combined
risk of cardiovascular events for women and men is apparent from these
randomized studies. Aspirin use is also associated with a significant
risk of major bleeding irrespective of sex. Both the beneficial and
harmful effects of aspirin should be considered by the physician and
patient before initiating aspirin for the primary prevention of
cardiovascular disease in both sexes," the authors conclude.
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