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Previous Volume 352:1293-1304 March 31, 2005 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Levin, R. I. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Randomized trials have shown that low-dose aspirin decreases the risk of a first myocardial infarction in men, with little effect on the risk of ischemic stroke. There are few similar data in women.

Methods We randomly assigned 39,876 initially healthy women 45 years of age or older to receive 100 mg of aspirin on alternate days or placebo and then monitored them for 10 years for a first major cardiovascular event (i.e., nonfatal myocardial infarction, nonfatal stroke, or death from cardiovascular causes).

Results During follow-up, 477 major cardiovascular events were confirmed in the aspirin group, as compared with 522 in the placebo group, for a nonsignificant reduction in risk with aspirin of 9 percent (relative risk, 0.91; 95 percent confidence interval, 0.80 to 1.03; P=0.13). With regard to individual end points, there was a 17 percent reduction in the risk of stroke in the aspirin group, as compared with the placebo group (relative risk, 0.83; 95 percent confidence interval, 0.69 to 0.99; P=0.04), owing to a 24 percent reduction in the risk of ischemic stroke (relative risk, 0.76; 95 percent confidence interval, 0.63 to 0.93; P=0.009) and a nonsignificant increase in the risk of hemorrhagic stroke (relative risk, 1.24; 95 percent confidence interval, 0.82 to 1.87; P=0.31). As compared with placebo, aspirin had no significant effect on the risk of fatal or nonfatal myocardial infarction (relative risk, 1.02; 95 percent confidence interval, 0.84 to 1.25; P=0.83) or death from cardiovascular causes (relative risk, 0.95; 95 percent confidence interval, 0.74 to 1.22; P=0.68). Gastrointestinal bleeding requiring transfusion was more frequent in the aspirin group than in the placebo group (relative risk, 1.40; 95 percent confidence interval, 1.07 to 1.83; P=0.02). Subgroup analyses showed that aspirin significantly reduced the risk of major cardiovascular events, ischemic stroke, and myocardial infarction among women 65 years of age or older.

Conclusions In this large, primary-prevention trial among women, aspirin lowered the risk of stroke without affecting the risk of myocardial infarction or death from cardiovascular causes, leading to a nonsignificant finding with respect to the primary end point.

Source Information

From the Divisions of Preventive Medicine (P.MR., N.R.C., I-M.L., D.G., J.M.G., J.E.M., J.E.B.), Cardiovascular Medicine (P.MR., J.M.G.), and Aging (J.M.G., J.E.B.), Department of Medicine, Brigham and Women's Hospital, Harvard Medical School; the Department of Epidemiology, Harvard School of Public Health (P.MR., N.R.C., I-M.L., J.E.M., J.E.B.); Veterans Affairs Boston Healthcare System (J.M.G.); and the Department of Ambulatory Care and Prevention, Harvard Medical School (J.E.B.) — all in Boston; and the Departments of Medicine and Epidemiology and Public Health, University of Miami School of Medicine, and the Department of Biomedical Science, Center of Excellence, Florida Atlantic University, Miami (C.H.H.).

This article was published at www.nejm.org on March 7, 2005.

Address reprint requests to Dr. Buring at the Division of Preventive Medicine, Brigham and Women's Hospital, 900 Commonwealth Ave. East, Boston, MA 02215, or at jburing{at}rics.bwh.harvard.edu.

Full Text of this Article

Related Letters:

Aspirin in the Prevention of Cardiovascular Disease in Women
Schwartz D. J., Dalen J. E., Ridker P. M., Buring J. E.
Extract | Full Text | PDF  
N Engl J Med 2005; 352:2751-2752, Jun 30, 2005. Correspondence

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