The Role of Aspirin in Cardiovascular Disease Prevention inWomen
Jordan Hopkins, MD; Marian Limacher, MD
Jordan Hopkins, MD; Marian Limacher, MD
Abstract
Cardiovascular disease is the nation's number one killer of women. Through its actions on platelet inhibition, aspirin is an effective agent for primary and secondary cardiovascular disease prevention and for use with cardiac interventions. However, the evidence for aspirin's effectiveness in women differs by age and indication compared to men. As primary prevention, low dose aspirin is recommended for women over age 65 to reduce the risk of myocardial infarction and stroke while younger women at high risk for stroke may benefit from aspirin.
Cardiovascular disease is the nation's number one killer of women. Through its actions on platelet inhibition, aspirin is an effective agent for primary and secondary cardiovascular disease prevention and for use with cardiac interventions. However, the evidence for aspirin's effectiveness in women differs by age and indication compared to men. As primary prevention, low dose aspirin is recommended for women over age 65 to reduce the risk of myocardial infarction and stroke while younger women at high risk for stroke may benefit from aspirin.
Aspirin has benefits in other selected patient groups, including diabetics and patients presenting with ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction acute coronary syndrome (NSTEMI /ACS), peripheral arterial disease, stroke, coronary artery bypass graft (CABG), and percutaneous coronary intervention (PCI ). Alternative platelet therapy using dipyridamole or clopidogrel, alone orwith aspirin, provides some improved efficacy for reduction in recurrent events for NSTEMI, ASC and PCI, although bleeding risks may be greater. However, dual antiplatelet therapy is not currently recommended for primary prevention in even high risk subjects. Despite the evidence base and guidelines, the use of aspirin in women remains suboptimal and warrants improved provider and patient awareness.
Introduction
Cardiovascular disease (CVD) remains the leading cause of death for both men and women in the United States. [1] Although CVD has previously been considered a disease primarily affecting men, more women than men die from CVD in the United States each year.[1,2] More US women will die from CVD this decade than from all other causes combined.[3] Furthermore, CVD appears to carry a higher mortality rate in women than in men, particularly for younger women with myocardial infarction (MI). [4,5] Factors that may explain this disparity include the advanced age of onset for CVD in women versus men, as well as additional comorbidities, socioeconomic issues, and referral patterns.[6] Fortunately, overall CVD mortality has declined steadily since 1970, although the decline for women has lagged behind the rate of decline for men with coronary heart disease (CHD).[7] Based on data from the Nurses' Health Study, the incidence of CVD in women fell 31% from 1992 to 1994 compared to the rates of CVD from 1980 to 1982.[8] This decrease has been accomplished in large part by recognition and modification of cardiac risk factors through lifestyle modifications such as tobacco avoidance and also through improvements in blood pressure, cholesterol , and glycemic control. Indeed, recent estimates suggest that 44% of the decline in CVD is due to control of risk factors comparedto 47% attributed to treatment advances. [9]
Prevention, diagnosis, and treatment advancements have spurred the development and frequent updates of practice guidelines regarding CVD. With the recognition of the importance of CVD as a cause of morbidity and mortality in women, national authorities have directed increasing attention to appropriate assessment of primary and secondary risk of CVD in women. The 2007 update of guidelines for CVD prevention in women reaffirms that traditional CVD risk factors impart significant risk for women ( Table 1 ) while providing several distinct recommendations for women.[10 ] In particular, women younger than age 65 are possible candidates for aspirin use to prevent stroke but are not considered candidates for the use of aspirin for the primary prevention of CHD ( Table 2 ).[10 ]
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Introduction
Cardiovascular disease (CVD) remains the leading cause of death for both men and women in the United States. [1] Although CVD has previously been considered a disease primarily affecting men, more women than men die from CVD in the United States each year.[1,2] More US women will die from CVD this decade than from all other causes combined.[3] Furthermore, CVD appears to carry a higher mortality rate in women than in men, particularly for younger women with myocardial infarction (MI). [4,5] Factors that may explain this disparity include the advanced age of onset for CVD in women versus men, as well as additional comorbidities, socioeconomic issues, and referral patterns.[6] Fortunately, overall CVD mortality has declined steadily since 1970, although the decline for women has lagged behind the rate of decline for men with coronary heart disease (CHD).[7] Based on data from the Nurses' Health Study, the incidence of CVD in women fell 31% from 1992 to 1994 compared to the rates of CVD from 1980 to 1982.[8] This decrease has been accomplished in large part by recognition and modification of cardiac risk factors through lifestyle modifications such as tobacco avoidance and also through improvements in blood pressure, cholesterol , and glycemic control. Indeed, recent estimates suggest that 44% of the decline in CVD is due to control of risk factors comparedto 47% attributed to treatment advances. [9]
Prevention, diagnosis, and treatment advancements have spurred the development and frequent updates of practice guidelines regarding CVD. With the recognition of the importance of CVD as a cause of morbidity and mortality in women, national authorities have directed increasing attention to appropriate assessment of primary and secondary risk of CVD in women. The 2007 update of guidelines for CVD prevention in women reaffirms that traditional CVD risk factors impart significant risk for women ( Table 1 ) while providing several distinct recommendations for women.[10 ] In particular, women younger than age 65 are possible candidates for aspirin use to prevent stroke but are not considered candidates for the use of aspirin for the primary prevention of CHD ( Table 2 ).[10 ]
DOWNLOAD COMPLETE PDF HERE
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