Clinical Question: Does aspirin in...

Clinical Question: Does aspirin intercept cardiovascular disease in women?

Setting: Population-based

close attention Design: Randomized controlled trial (double-blinded)

Allocation: Uncertain

Synopsis: greatest in quantity of the data on the use of aspirin for the prevention of cardiovascular adventures come from studies in men The common study represents the largest and best evidence to date for women Women older than 45 years without a history of coronary artery disease, cerebrovascular disease, or cancer were initially listed in a three-month placebo run-in period to establish compliance with the meditation protocol. Women who complied from end to end the run-in period (n = 39876) were randomized to receive 100 mg of aspirin daily or matching placebo. They were followed for a mean of 10 years, with 97 percent integral data on morbidity and 99 percent integral data on mortality.

The mean age of participants was 55 years, and the 10-year risk of heart disease was les than 5 percent in 85 percent of the women disposes were balanced at the start of the contemplation outcomes were assessed blindly, and analysis was at intention to treat. Women taking aspirin were les likely to have a calamity (1.1 versus 1.3 percent; P = 04; number destitutioned to treat [NNT] = 444 for 10 years) or transient ischemic attack (09 versus 12 percent; P = 01; NNT = 384 for 10 years) than women taking placebo. However, there were no differences between collections in the likelihood of myocardial infarction (099 percent for aspirin and 097 percent for placebo) or death from cardiovascular causes (060 versus 063 percent) any major cardiovascular marked occurrence (2.4 versus 2.6 percent), or death from any cause (31 versus 32 percent) Gastrointestinal drip saps requiring transfusion were more belonging to all in the aspirin group (064 versus 046 percent; P = 02; number distressed to treat to harm [NNH] = 553 for 10 years).

The subject of attention was powered to have an 86 percent chance to find out a 25 percent reduction in the primary issue of any major cardiovascular circumstance Review of the survival turn reveals a steady but small tend in favor of aspirin regarding the primary consequence This apparent benefit, equivalent to a 5 to 10 percent relative reduction in the rate of all-cause mortality, was not statistically significant despite the large size of the study

Bottom Line: Aspirin makes the risk of stroke and transient ischemic attack in women nevertheless does not reduce the risk of myocardial infarction or cardiovascular death. The reduction in afflictions over 10 years (NNT = 444) must be balanced against an increase in serious gastrointestinal bleeding (NNH = 553) No change regarding all-cause mortality was seen in this large, prolonged study. (Level of Evidence: 1b)

subject of attention Reference: Ridker PM, et al. A randomized trial of low-dose aspirin in the primary prevention of cardiovascular disease in women N Engl J M March 31 2005;352:1293-304

Used with permission from Ebell M ASA obstructs stroke, not MI, in women Accessed online June 1 2005 at: http://www.InfoPOEMs.com.

COPYRIGHT 2005 American Academy of Family Physicians

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