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Original Articles

Aspirin Use, Dose, and Clinical Outcomes in Postmenopausal Women With Stable Cardiovascular Disease

The Women’s Health Initiative Observational Study

Jeffrey S. Berger, MD, MS; David L. Brown, MD; Gregory L. Burke, MD, MSc; Albert Oberman, MD, MPH; John B. Kostis, MD; Robert D. Langer, MD, MPH; Nathan D. Wong, PhD and Sylvia Wassertheil-Smoller, PhD

From the Department of Medicine (Cardiovascular Medicine), University of Pennsylvania, Philadelphia, Penn. and Duke Clinical Research Institute, Durham, NC (J.S.B.); Department of Medicine (Cardiovascular Medicine), Stony Brook University Medical Center, Stony Brook, NY (D.L.B.); Department of Public Health Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC (G.L.B.); Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham (A.O.); Division of Cardiovascular Diseases and Hypertension, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, New Brunswick, NJ (J.B.K.); University of California, San Diego (R.D.L.); Heart Disease Prevention Program, Department of Medicine, University of California, Irvine (N.D.W.); Department of Epidemiology and Social Medicine, Albert Einstein College of Medicine, New York, NY (S.W.-S.). Dr Langer is presently at Jackson Hole Center for Preventive Medicine, Jackson Hole, Wyo.

Correspondence to Jeffrey S. Berger, MD, MS, Division of Cardiovascular Medicine, University of Pennsylvania, 6 Penn Towers, Philadelphia, PA 19104. E-mail Jeffrey.berger{at}uphs.upenn.edu

Received May 12, 2008; accepted January 7, 2009.

Background— Despite compelling evidence that aspirin reduces fatal and nonfatal vascular events among the overall population in various settings, women have frequently been underrepresented and their data underreported. We sought to evaluate the relationship between aspirin use, dose (81 or 325 mg), and clinical outcomes among postmenopausal women with stable cardiovascular disease (CVD).

Methods and Results— Women with CVD (n=8928) enrolled in the Women’s Health Initiative Observational Study were used for this analysis. The primary outcome was the incidence of all-cause mortality and cardiovascular events (myocardial infarction, stroke, and cardiovascular death). Among 8928 women with stable CVD, 4101 (46%) reported taking aspirin, of whom 30% were on 81 mg and 70% were on 325 mg. At 6.5 years of follow-up, no significant association was noted for aspirin use and all-cause mortality or cardiovascular events. However, after multivariate adjustment, aspirin use was associated with a significantly lower all-cause (adjusted hazard ratio, 0.86 [0.75 to 0.99]; P=0.04) and cardiovascular-related mortality (adjusted hazard ratio, 0.75 [0.60 to 0.95]; P=0.01) compared with no aspirin. Aspirin use was associated with a lower risk of cardiovascular events (adjusted hazard ratio, 0.90 [0.78 to 1.04]; P=0.14), which did not meet statistical significance. Compared with 325 mg, use of 81 mg was not significantly different for all-cause mortality, cardiovascular events, or any individual end point.

Conclusions— After multivariate adjustment, aspirin use was associated with significantly lower risk of all-cause mortality, specifically, cardiovascular mortality, among postmenopausal women with stable CVD. No significant difference was noted between 81 mg and 325 mg of aspirin. Overall, aspirin use was low in this cohort of women with stable CVD.

Key Words: aspirin • dose • women • cardiovascular disease • drugs • mortality • observational study

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CLINICAL PERSPECTIVE

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