Gender Differences in the Primary Prevention of Stroke with Aspirin

Abstract

Aspirin is used to prevent ischemic stroke and other types of cardiovascular disease. Seven trials of aspirin focusing on the effectiveness of primary prevention of stroke and other cardiovascular events have been performed, but three of these did not include women. Data from these trials, and one meta-ana lysis, suggest that aspirin prevents myocardial infarction in men and stroke in women, although the findings in women were driven by the results of a single large study, and a subsequent meta-ana lysis did not find a gender difference. The reasons for the possible gender differences in aspirin's effectiveness are not entirely clear. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Future Medicine Ltd. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians.Medscape, LLC designates this Journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at www.medscape.org/journal/wh; (4) view/print certificate. Release date: 25 May 2011; Expiration date: 25 May 2012 Learning objectivesUpon completion of this activity, participants should be able to:• Describe gender-specific findings from trials of aspirin focusing on the effectiveness of primary prevention of stroke and other cardiovascular events• Describe professional society guidelines regarding use of aspirin for primary prevention of stroke and other cardiovascular events in women• Describe risks of aspirin used for primary prevention of stroke and other cardiovascular events in women REviEw -Adelman, Lisabeth & Brown CMEIn the USA, stroke is the third leading cause of death and the leading cause of disability [1]. While treatments for acute stroke and options for secondary stroke prevention have proliferated in recent years, the greatest potential to reduce the impact of stroke lies in primary prevention. Every year in the USA there are close to 800,000 strokes [1]. While approximately 185,000 are recurrent strokes, approximately three-quarters are new events and greater than half occur in women [1]. Risk factors for stroke such as hypertension, smoking, diabetes, physical inactivity and obesity are becoming more prevalent in an aging US population. Lost earnings and caregiving costs due to stroke put a tremendous burden on society and underscore the need for effective preventive strategies [2]. Given disparities in stroke burden by gender, these s trategies should be assessed in both men and women.The ancient Greeks knew that willow bark had analgesic properti...

Sex and the Lab: An Alcohol‐Focused Commentary on the NIH Initiative to Balance Sex in Cell and Animal Studies

“…Sex hormones can modulate the γ-aminobutyric acid (GABA) receptor, a common site of anesthetic drugs, leading to sexually dimorphic effects of anesthetics (Frye and Duncan, 1994). Clinical studies show that differential preventive effects are achieved with low-dose aspirin in women and men (Adelman et al, 2011). Similarly, Zolpidem, a drug used to treat insomnia, requires different dosing in women and men (Greenblatt et al, 2014).…”

Aspirin for prophylactic use in the primary prevention of cardiovascular disease and cancer: a systematic review and overview of reviews

“…To determine whether screening the general population for a low ABI could identify a higher-risk group who might derive substantial benefit from aspirin therapy HOT 1998 43 TPT 1998 48 PPP 2001 41 WHS 2005 46 POPADAD 2008 40 JPAD 2008 44 AAA 2010 42 Adelman 2011, 52 USA…”

“…In this section we report on the four selected most recent study-level reviews, [37][38][39]56 the Antithrombotic Trialists (ATT) IPD-level meta-analysis 53 and we discuss two further relevant reviews. 52,70 Seshasai et al 2012…”

“…Adelman et al 52 undertook a study-level subgroup analysis by sex. The primary outcome for this meta-analysis was stroke.…”

“…We included nine systematic reviews [37][38][39][52][53][54][55][56][57] of RCTs which investigated use of aspirin for primary prevention of CVD. These reviews were of good quality.…”