Connect
MJA
MJA

Aspirin for primary prevention of cardiovascular disease in women: does sex matter?

Joseph Hung
Med J Aust 2006; 184 (6): . || doi: 10.5694/j.1326-5377.2006.tb00231.x
Published online: 20 March 2006

Recommendations for primary prevention in women need to be different

The efficacy of low-dose aspirin for the secondary prevention of cardiovascular disease among men and women is established.1,2 However, the risk-to-benefit ratio for aspirin in primary prevention is much less clear.2,3 The National Heart Foundation has recommended that low-dose aspirin be considered for people without symptoms but at increased (> 1% annual) risk of a coronary heart disease event.4 This recommendation is based on earlier primary prevention trials, with over 55 000 participants, showing a significant 32% reduction in the risk of myocardial infarction, but no significant change in risk of stroke or cardiovascular death.3 However, women comprised only 20% of trial participants, and fewer than 180 of the 2402 cardiovascular events occurred in women.3,5 Until recently, there has been limited direct evidence for the efficacy of aspirin in primary prevention among women.


  • University of Western Australia, Perth, WA.


Correspondence: 

  • 1. Antithrombotic Trialists’ Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ 2002; 324: 71-86.
  • 2. Hung J. Aspirin for cardiovascular disease prevention. Med J Aust 2003; 179: 147-152. <MJA full text>
  • 3. Hayden M, Pignone M, Phillips C, Mulrow C. Aspirin for the primary prevention of cardiovascular events: a summary of the evidence for the US Preventive Services Task Force. Ann Intern Med 2002; 136: 161-172.
  • 4. National Heart Foundation Australia. Aspirin for cardiovascular disease prevention. Available at: http://www.heartfoundation.com.au/index.cfm?page=39 (accessed Feb 2006).
  • 5. 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. N Engl J Med 2005; 352: 1293-1304.
  • 6. Berger JS, Roncaglioni MC, Avanzini F, et al. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-anlysis of randomized controlled trials. JAMA 2006; 295: 306-313.
  • 7. Final report on the aspirin component of the ongoing Physicians’ Health Study. Steering Committee of the Physicians’ Health Study Research Group. N Engl J Med 1989; 321: 129-135.
  • 8. Nelson MR, Liew D, Bertram M, Vos T. Epidemiological modelling of routine use of low dose aspirin for the primary prevention of coronary heart disease and stroke in those aged 70. BMJ 2005; 330: 1306.
  • 9. Montgomery PR, Berger LD, Miteno PA, Sitar DS. Salicylate metabolism: effects of age and sex in adults. Clin Pharmacol Ther 1986; 39: 571-576.
  • 10. Levin RJ, Harpel PC, Well D, et al. Aspirin inhibits vascular plasminogen activator in vivo: studies utilizing a new assay to quantify plasminogen activator activity. J Clin Invest 1984; 74: 571-580.
  • 11. Iemolo F, Martiniuk A, Steinman DA, Spence JD. Sex differences in carotid plaque and stenosis. Stroke 2004; 35: 477-481.
  • 12. National Heart Foundation. Aspirin for cardiovascular disease prevention. Position statement 2003 (addendum 2005). Avalable at: http:// www.heartfoundation.com.au/index.cfm?page+39. (accessed Mar 2006).

Author

remove_circle_outline Delete Author
add_circle_outline Add Author

Comment
Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Online responses are no longer available. Please refer to our instructions for authors page for more information.