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Editorials

Aspirin Therapy in Women

Back to the ABCs

Samia Mora, MD, MHS

From the Divisions of Cardiovascular Disease and Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Samia Mora, MD, MHS, Brigham and Women’s Hospital, 900 Commonwealth Avenue E, Boston, MA 02215. E-mail smora@partners.org

Key Words: aspirin • cardiovascular diseases • women

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Comprehensive risk-factor management is the cornerstone of therapy in women and men with known cardiovascular disease (CVD). Therapeutic interventions can be summarized in an "ABC" format (Table).^1–3 CVD death rates have declined in men and older women during the past decade.⁴ By contrast, there has been a significant rise in CVD deaths among younger women.⁵ Evidence-based therapies, including aspirin use, have been believed to account for half of the decline in CVD death rates, whereas improvement in risk factors, including lower cholesterol and blood pressure, accounts for the other half.⁶

View this table:   Table. ABCs of CVD Therapies

 

Article see p 78

The use of aspirin in medicine dates at least as far back as Hippocrates, who found analgesic effects for the extract (salicin) of white willow bark.⁷ Aspirin irreversibly inactivates platelet cyclooxygenase, preventing platelets from synthesizing thromboxane A₂, a potent vasoconstrictor and promoter of platelet aggregation. Aspirin also has anti-inflammatory and vasodilatory effects that may be important.

Over the past 3 decades, aspirin has been shown to decrease the risk of CVD events and mortality in clinical trials of men and women with CVD.⁸ The latest meta-analysis by the Antiplatelet Trialists’ collaboration in 2002 analyzed 135 000 patients with CVD. Compared with placebo, antiplatelet therapy (mostly aspirin) resulted in a relative risk reduction of about one quarter for CVD events, one third for nonfatal myocardial infarction, one quarter for stroke, and 15% for CVD mortality.⁹ Antiplatelet therapy reduced the relative risk of ischemic stroke by 30% but increased the . . . [Full Text of this Article]

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