0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Review |

Aspirin for the Primary Prevention of Cardiovascular Events in Women and Men A Sex-Specific Meta-analysis of Randomized Controlled Trials

Jeffrey S. Berger, MD, MS; Maria C. Roncaglioni, MD; Fausto Avanzini, MD; Ierta Pangrazzi, MD; Gianni Tognoni, MD; David L. Brown, MD
JAMA. 2006;295(3):306-313. doi:10.1001/jama.295.3.306.
Text Size: A A A
Published online

Context Aspirin therapy reduces the risk of cardiovascular disease in adults who are at increased risk. However, it is unclear if women derive the same benefit as men.

Objective To determine if the benefits and risks of aspirin treatment in the primary prevention of cardiovascular disease vary by sex.

Data Sources and Study Selection MEDLINE and the Cochrane Central Register of Controlled Trials databases (1966 to March 2005), bibliographies of retrieved trials, and reports presented at major scientific meetings. Eligible studies were prospective, randomized controlled trials of aspirin therapy in participants without cardiovascular disease that reported data on myocardial infarction (MI), stroke, and cardiovascular mortality. Six trials with a total of 95 456 individuals were identified; 3 trials included only men, 1 included only women, and 2 included both sexes.

Data Extraction Studies were reviewed to determine the number of patients randomized, mean duration of follow-up, and end points (a composite of cardiovascular events [nonfatal MI, nonfatal stroke, and cardiovascular mortality], each of these individual components separately, and major bleeding).

Data Synthesis Among 51 342 women, there were 1285 major cardiovascular events: 625 strokes, 469 MIs, and 364 cardiovascular deaths. Aspirin therapy was associated with a significant 12% reduction in cardiovascular events (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.79-0.99; P = .03) and a 17% reduction in stroke (OR, 0.83; 95% CI, 0.70-0.97; P = .02), which was a reflection of reduced rates of ischemic stroke (OR, 0.76; 95% CI, 0.63-0.93; P = .008). There was no significant effect on MI or cardiovascular mortality. Among 44 114 men, there were 2047 major cardiovascular events: 597 strokes, 1023 MIs, and 776 cardiovascular deaths. Aspirin therapy was associated with a significant 14% reduction in cardiovascular events (OR, 0.86; 95% CI, 0.78-0.94; P = .01) and a 32% reduction in MI (OR, 0.68; 95% CI, 0.54-0.86; P = .001). There was no significant effect on stroke or cardiovascular mortality. Aspirin treatment increased the risk of bleeding in women (OR, 1.68; 95% CI, 1.13-2.52; P = .01) and in men (OR, 1.72; 95% CI, 1.35-2.20; P<.001).

Conclusions For women and men, aspirin therapy reduced the risk of a composite of cardiovascular events due to its effect on reducing the risk of ischemic stroke in women and MI in men. Aspirin significantly increased the risk of bleeding to a similar degree among women and men.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Figures

Figure 1. Flow Diagram of the Trial Selection Process
Graphic Jump Location
Figure 2. Effect of Aspirin Treatment on the Primary Prevention of Major Cardiovascular Events and Myocardial Infarction
Graphic Jump Location

Sizes of data markers are proportional to the amount of data contributed by each trial. Test for heterogeneity for cardiovascular events: women, P = .47; men, P = .25; and myocardial infarction: women, P = .62; men, P = .05. BDT indicates British Doctor's Trial; CI, confidence interval; HOT, Hypertension Optimal Treatment trial; PHS, Physicians' Health Study; PPP, Primary Prevention Project; TPT, Thrombosis Prevention Trial; WHS, Women's Health Study.

Figure 3. Effect of Aspirin Treatment on the Primary Prevention of Stroke, Ischemic Stroke, and Hemorrhagic Stroke
Graphic Jump Location

Sizes of data markers are proportional to the amount of data contributed by each trial. Test for heterogeneity for stroke: women, P = .72; men, P = .80; ischemic stroke: women, P = .82; men, P = .81; and hemorrhagic stroke: women, P = .25; men, P = .78. See legend of Figure 2 for expansions of study names. CI indicates confidence interval.

Figure 4. Effect of Aspirin Treatment on the Primary Prevention of Cardiovascular Mortality and Total Mortality
Graphic Jump Location

Sizes of data markers are proportional to the amount of data contributed by each trial. Test for heterogeneity for cardiovascular mortality: women, P = .18; men, P = .41; and total mortality: women, P = .12; men, P = .53. See legend of Figure 2 for expansions of study names. CI indicates confidence interval.

Figure 5. Effect of Aspirin Treatment on Major Bleeding
Graphic Jump Location

Sizes of data markers are proportional to the amount of data contributed by each trial. Test for heterogeneity: women, P = .21; men, P = .68. See legend of Figure 2 for expansions of study names. CI indicates confidence interval.

Tables

References

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.

Multimedia

Some tools below are only available to our subscribers or users with an online account.

7,547 Views
362 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com
×
brightcove.createExperiences();